Presentation Authors: Nikhil Khandelwal*, Bikaner, India, Mahakshit Bhat, Amilal Bhat, Jaipur, India, Akshita Bhat, Bikaner, India, Vikash Singh, Jodhpur, India
Introduction: The controversy exists regarding the management of >10 mm size calculus. URSL has advantage of higher stone free rate in a single sitting but at the cost of higher morbidity and complication rate than SWL. Currently, percutaneous access for upper ureteric calculus is recommended only in few special situations like large, impacted calculi that have failed other modes of treatment, associated with distal-ureteric stricture and in patients with urinary diversions. Objective of the study was to compare the outcome of antegrade percutaneous ureterolithotripsy with retrograde ureteroscopic lithotripsy for upper ureteric calculus in respect to stone clearance, morbidity and complications.
Methods: A prospective study done between December 2014 and June 2016. Total 117 patients with upper ureteric calculus sized (10-20) mm underwent APCUL or URSL. All demographic data, mean operative/anaesthesia time, postoperative hospital stay, complications and stone free rates were recorded and compared.
Results: APCUL and URSL were performed in 64 and 53 patients respectively.The mean age and stone size were comparable in both groups. The stone clearance rate at 1 month follow-up was 93.75% in antegrade group and 81.13% in retrograde group (p=0.036). Mean anesthesia time was significantly higher for APCUL group while the actual mean operative time was significantly higher for URSL group (p < 0.001). The overall complication rates were higher in antegrade group (p=0.804) but the major complications of Clavien grade III or more happened only in retrograde group (p=0.007). Postoperative pain score was significantly higher in antegrade group (p=0.048). Antegrade group had more incidence of gross hematuria. Blood transfusion was needed in 7.8% patients in antegrade group while none in URSL group (p=0.500). Patients of antegrade group stayed more in postoperative period (36.02Â±13.99 vs 30.26Â±9.37 hours, p=0.012). In URSL group, stone retropulsion occurred in 4 patients, three were treated subsequently by shock wave lithotripsy (SWL) and one by percutaneous nephrolithotomy in a second setting.
Conclusions: APCUL had better stone-free rates than URSL for an upper ureteral stone of size 10-20 mm. Though the postoperative minor complications were higher in antegrade group but the severe complications occurred in retrograde group only. So, antegrade approach can be considered as preferred option to achieve higher clearance rate in a single setting.