Urinary tract stones affect approximately 5–10% of people in developed countries. Advances in urological treatment have provided several surgical options, including ureteroscopic lithotripsy (URSL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (ESWL), and minimally invasive laparoscopic or retroperitoneoscopic procedures. Retroperitoneoscopic surgery provides access to the urinary tract through the retroperitoneal space and can be used for pyelolithotomy and ureterolithotomy. This prospective, randomised study compared retroperitoneoscopic surgery with endourological techniques for upper ureteric and renal pelvic stones measuring 1.5–2.5cm. Sixty adult patients were included and randomly divided into two groups of 30. Group A underwent retroperitoneoscopic pyelolithotomy or ureterolithotomy, while Group B underwent RIRS or URSL. Outcomes assessed included operative time, hospital stay, stone clearance, postoperative complications and recovery. The results demonstrated important differences between the two approaches. Endourological treatment had a significantly shorter operative time, averaging 48.3 minutes compared with 74.2 minutes for retroperitoneoscopic surgery. Hospitalisation was also shorter in the endourology group, at approximately 1.4 days compared with 1.9 days. However, retroperitoneoscopic surgery achieved substantially higher stone clearance, with an average clearance of 99.5%, compared with 93.2% for endourological treatment. Complications were slightly less frequent with the retroperitoneoscopic approach (20% versus 30%). Overall, both techniques were considered safe and effective when performed by experienced surgeons. Endourological treatment may be preferable for smaller, non-impacted stones when rapid recovery is important. Retroperitoneoscopic surgery may be more suitable for larger or impacted stones where achieving maximum stone clearance in a single procedure is the priority. The study has limitations, including its small sample size, single-centre design, short follow-up, lack of blinding, and absence of long-term assessment of recurrence or re-intervention. The authors conclude that treatment should be individualised according to stone characteristics and patient factors, while further larger, multicentre studies are needed.
Comparing retroperitoneoscopic and endourological approaches for upper ureteric and renal pelvic calculi
Reviewed by Asih H Ansari
A prospective randomised comparative study of retroperitoneoscopic and endourological approaches for upper ureteric and renal pelvic calculi (1.5–2.5cm).
