A Comparison of Minimally Invasive Surgery Ureterolithotomy and Transurethral Lithotripsy in Combination with Retrograde Intrarenal Surgery: A Randomized Clinical Trial

Introduction: Establishing good efficacy and safety of non-invasive methods compared to conventional methods would result in a higher ability for decision-making about the best therapeutic approach in patients with large ureteral calculi. Accordingly, this study was carried out to compare the efficacy of minimally invasive surgical ureterolithotomy (MISU) versus Transurethral Lithotripsy (TUL) plus Retrograde Intrarenal Surgery (RIRS) in patients with ureteral stones larger than 15 mm.Methods:  In this single-blind randomized clinical trial, 74 consecutive patients with ureteral stones larger than 15 mm attending Urology Clinic, Sina Hospital, and Tehran, Iran, in 2017 were enrolled. Patients were randomly assigned to undergo minimally invasive surgical ureterolithotomy or TUL plus RIRS. Then the cases with remained stones over 2 mm after treatment were recognized by imaging and stone-free rate (SFR) was determined and compared across the groups.Results: Longer hospital stay, larger Apotel Infusion dose, and longer operation time were seen in the MISU group (P-value ≤ 0.00). The stone-free rate was 94.6% and 97.3% in TUL plus RIRS and MISU groups, respectively (P-value=1.00). The rates of adverse effects were alike across the groups (P-value=0.95), considering fever that was higher in TUL plus RIRS group.Conclusions: Laparoscopic ureterolithotomy was an effective and safe surgical procedure for a minimally invasive strategy when first-line therapeutic approaches were unsuccessful in patients with larger ureteral stones.