The comparison of ureteroscopy and ureterolithotomy for the treatment of large and impacted ureteral stones in the middle and upper part of ureter

Objective: We aimed to research the most effective treatment method of the middle and upper ureteral impacted stones of which is 1.5-2 cm diameter size.
Material and Method: Between 2000 and 2013, 75 patients who had impacted stone size of between 1.5-2cm at the middle and upper part of the ureter were examined. Patients had been analysed in terms of their demographical characteristics, stone size, hospitalization time, stone- free and complication rates. For statistical analysis Pearson’s chi-square, Mann Whitney-U and student-t tests has applied. The significance level is determined as p<0.05.
Results: Sixty five ureteroscopy and twenty four ureterolithotomy, a total of 87 treatment method had been given to 75 patients. Ureteroscopy had been applied by semi rigid ureteroscope. Eleven of twenty four patients ureterolithotomy were open surgery and 13 were laparoscopic ureterolithotomy. Stone size wasn’t greater in the group which has received ureterolithotomy examination compared to group received ureteoscopy examination (503-395 mm3 p=0.172). The hospitalization times was similar for each group (3.4-4.1 days p=0.086). The stone- free rate was 96% for ureterolithotomy group and 46% for ureteroscopy group. Ureterolithotomy has been found more successful then ureteroscopy (p=0.01). Although ureterolithotomy group has only one complications (4%), 1 patient in ureteroscopy group faced with total avulsion and 2 patients were faced ureteral perforation (6.3%).
Conclusion: Due to the failure of semi rigid ureteroscope and the high major possibility of complication even if there is not a flexible ureteroscope option, laparoscopic ureterolithotomy or open surgery can be applied instead of ureteroscopy for the treatment of stones which is seen at the upper and middle part of the ureter.

Üreter orta ve üst bölümünde görülen büyük impakte taþlarýn tedavisinde üreteroskopi ve üreterolitotominin karþýlaþtýrýlmasý

Amaç: Üreter orta ve üst bölümünde görülen 1.5-2 cm arasý impakte taþlarýn tedavisinde en etkin tedavi yönteminin araþtýrýlmasýný amaçladýk.
Gereç ve Yöntem: 2000-2013 yýllarý arasýnda üreter orta ve üst bölümünde 1.5-2.0 cm boyutunda impakte taþý olan ve kliniðimizde opere edilen 75 hasta çalýþmaya alýndý. Hastalar demografik verileri, taþ hacimleri, hastanede kalma süreleri, taþsýzlýk ve komplikasyon oranlarý açýsýndan karþýlaþtýrýldý. Ýstatistiksel analiz için Pearson ki-kare, Mann Whitney-U ve student-t testi kullanýldý. Anlamlýlýk sýnýr deðeri p<0.05 olarak kabul edildi.
Bulgular: Yetmiþbeþ hastaya altmýþüçü üreteroskopi ve yirmidördü üreterolitotomi olmak üzere toplam 87 ünite tedavi uygulandý. Üreteroskopi semi- rijid üreteroskopla yapýldý. Üreterolitotomilerin 11’i açýk, 13’ü laparoskopik yapýldý. Taþ hacimleri arasýnda anlamlý bir fark yoktu (503-395 mm3 p=0.172). Hastanede kalma süreleri iki grup arasýnda benzerdi (3.4-4.1 gün p=0.086). Taþsýzlýk oranlarý karþýlaþtýrýldýðýnda üreterolitotomi grubunda %96, üreteroskopi grubunda %46 olarak bulundu.
Üreterolitotomi, üreteroskopiden anlamlý olarak daha baþarýlý bulundu (p=0.01). Üreterolitotomi grubunda sadece bir hastada komplikasyon geliþirken (%4); üreteroskopi grubunda bir hastada total avulsiyon, iki hastada açýða geçmeyi gerektiren perforasyon geliþti (%6.3).
Sonuç: Üreter üst ve orta bölümü taþlarýnýn tedavisinde semi- rijid üreteroskopinin düþük baþarýsý ve yüksek majör komplikasyon oraný düþünülerek, fleksible üreteroskopi imkaný da yoksa, üreteroskopi yapmadan, laparoskopik veya açýk üreterolitotomi düþünülebilir.