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Abstract

Background: The proximal ureteral stone presents a difficult clinical entity which is an ongoing problem and necessitates the application of optimal treatment strategy in order to achieve satisfactory outcomes. Each of the available modalities, namely Extracorporeal Shock Wave Lithotripsy (ESWL), Ureterolithotripsy and Laparoscopic Ureterolithotomy, are efficient and safe with corresponding differences in therapeutic efficacy and safety profiles.
Objective: To compare the efficacy and clinical outcomes of ESWL, Ureterolithotripsy, and Laparoscopic Ureterolithotomy in the treatment of large proximal ureteral stones.
Material and Methods: This randomized controlled study was conducted in the Urology Department, Chandka Medical College, Larkana from June 2022 to May 2024. Total 75 patients with large proximal ureteral stones (≥10 mm) were selected for this study.  Selected patients were randomized into three groups of 25 each: Ureterolithotripsy, ESWL, Laparoscopic Ureterolithotomy. Clinical parameters, including rate of stone clearance, time to stone clearance, hospital stay, pain score, and residual stones were examined. ANOVA and Chi-square tests determined statistical analysis at p < 0.05.
Results: Laparoscopic Ureterolithotomy achieved the highest stone clearance rate (100%), followed by Ureterolithotripsy (92%) and ESWL (44%) (p < 0.001). The time to stone clearance was shortest in the Laparoscopic group (8.00 ± 3.55 days) and longest in the ESWL group (17.88 ± 7.90 days) (p < 0.001). Pain scores were lowest in the Laparoscopic group (3.16 ± 1.14) and highest in the ESWL group (5.92 ± 1.29) (p < 0.001). Residual stones were significantly more frequent in the ESWL group (56%) compared to Ureterolithotripsy (8%) and Laparoscopic Ureterolithotomy (0%) (p < 0.001).
Conclusion: Laparoscopic Ureterolithotomy provides better efficacy with stone clearance for large proximal ureteral stones and Ureterolithotripsy is good alternatives, with less complications. However, ESWL is still a noninvasive option for select patients. A patient specific or resource available treatment option should be chosen.