Comparative Study between Flexible Ureteroscopy and Semirigid Ureteroscopy in Management of Upper Ureteric Stones using Laser Lithotripsy

Background:  There are various options in the management of proximal ureteral stones, which includes medical expulsive therapy, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS; retrograde), percutaneous nephrolithotomy (PCNL), laparoscopy (LAP), and open surgery.
Objective: The aim of this study was to evaluate the efficacy and safety of both semirigid and flexible ureteroscopy in management of upper ureteric stones using laser lithotripsy.
Patients and Methods:  To achieve this goal, this prospective study was done at the urology department, Ain Shams University Hospitals on 60 patients with upper ureteric stones less than 2 cm in size. They were divided into groups of 30 patients in each group. Patients in group A were treated by semirigid ureteroscopy. While patients in group B were treated by flexible ureteroscopy using laser lithotripsy in both procedures.
Results: Stone free rate was 90.0% in group A while it was 93.3% in group B. Mean operative time was 55.07 ± 13.24 min in Group A while it was 64.63 ± 17.33 min in Group B. Success rate was 76.7% in group A, while it was 90.0% in group B. 20% of patients in group A had intra or postoperative complications in the form of: 6.7% of cases had failure to access to the stone, in 3.3% of cases there was upward  migration of stone toward kidneys, 3.3% of cases had ureteral submucosal injury, 3.3% of patients had postoperative fever and 3.3% of patients developed haematuria.
Conclusion: Flexible ureteroscopy is a favorable option for patients having proximal ureteral stones with higher stone free rate and success rate.  On the other hand, semirigid ureteroscopy is an acceptable alternative for treatment of proximal ureteral stones. Flexible ureteroscopy costs is much higher compared to semirigid ureteroscopy