Comparative Outcomes of Antegrade Flexible Ureteroscopy and Retrograde Intrarenal Surgery in the Management of Large Upper Ureteric Stones
Abstract
Introduction: Ureterolithiasis, the presence of calculi within the ureter, is a prevalent urological condition with increasing global incidence and significant health implications. The management of large upper ureteric stones, particularly those exceeding 10 mm, often necessitates surgical intervention. Among the available minimally invasive techniques, both antegrade flexible ureteroscopy (AFU) and retrograde intrarenal surgery (RIRS) have demonstrated clinical utility. However, comparative outcomes between these approaches remain a subject of ongoing evaluation. This study aims to assess and compare the effectiveness and perioperative outcomes of AFU versus RIRS in the management of large upper ureteric stones.
Materials and Methods: A prospective randomized controlled trial was conducted at Zagazig University Hospitals, enrolling patients with upper ureteric stones larger than 10 mm. Participants were randomly assigned to either Group A (AFU) or Group B (RIRS). Comparative analyses were performed regarding patient demographics, stone characteristics, operative parameters, and postoperative outcomes. Statistical analysis was carried out using SPSS software, with a p-value < 0.05 considered statistically significant.
Results: A total of 120 patients were included, with 60 in each group. Baseline demographic parameters, including age, sex, body mass index, and comorbidities, were comparable between the groups. Notable differences were observed in operative data: AFU was associated with a shorter operative duration (71.3 ± 11.19 minutes vs. 74.9 ± 8.56 minutes; p = 0.041) and reduced stone disintegration time (p < 0.001). Additionally, the AFU group experienced significantly shorter hospital stays (3.43 ± 0.53 days vs. 4.13 ± 0.99 days; p < 0.001). Stone-free rates at 24 hours (95% vs. 90%) and at four weeks postoperatively (98.3% vs. 93.3%) were slightly higher in the AFU group, though these differences were not statistically significant. There were also no significant differences in postoperative complication rates or the need for auxiliary procedures.
Conclusion:Both AFU and RIRS are effective and safe modalities for the treatment of large upper ureteric stones. AFU offers certain procedural advantages, including reduced operative and hospitalization times, and may be particularly beneficial in cases where retrograde access is challenging. Nonetheless, stone clearance and complication profiles between the two techniques are largely comparable. AFU may serve as a valuable alternative in selected clinical scenarios.