title: Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis.
abstract: OBJECTIVE
  To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones.
  
  
  METHODS
  A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group.
  
  
  RESULTS
  It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001).
  
  
  CONCLUSIONS
  The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.
authors.affiliation: Selcuk Sahin, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Sahin
authors.affiliation: Berkan Resorlu, Department of Urology, Ondokuz Mayis Univercity, Faculty of Medicine, Samsun, Turkey.
authors.forename: Berkan
authors.initials: B
authors.lastname: Resorlu
authors.affiliation: Mithat Eksi, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Mithat
authors.initials: M
authors.lastname: Eksi
authors.affiliation: Bekir Aras, Department of Urology, Dumlupinar Univercity, Faculty of Medicine, Kutahya, Turkey.
authors.forename: Bekir
authors.initials: B
authors.lastname: Aras
authors.affiliation: Arda Atar, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Arda
authors.initials: A
authors.lastname: Atar
authors.affiliation: Volkan Tugcu, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
keywords: Flexible ureteroscopy; Laparoscopic ureterolithotomy; Obstructive pyelonephritis; Proximal ureteral stone; Transperitoneal