Comparison of Ureteroscopic Lithotripsy and Laparoscopic Ureterolithotomy for the Treatment of Unilateral Upper Ureteral Stone: A Randomized Controlled Trial at a Tertiary Care Hospital in Pakistan

Abstract

Objective: To compare the efficacy and perioperative outcomes of laparoscopic ureterolithotomy (LU) and ureteroscopic lithotripsy (URL) in patients with proximal ureteral stones measuring 10–20 mm. Methods: This study was designed as a prospective, randomised, controlled trial and conducted in the Department of Urology at Lahore General Hospital over three months i.e from 1st April, 2025 to 30th June, 2025. A total of fifty-six adult patients diagnosed with a solitary unilateral proximal ureteric stone were enrolled and randomly allocated into two equal treatment groups: laparoscopic ureterolithotomy (LU, n = 28) and ureteroscopic lithotripsy (URL, n = 28). The primary objectives of the study included operative duration, postoperative hospitalisation, and stone-free rate (SFR). Secondary endpoints comprised perioperative adverse events, categorised according to the Clavien–Dindo classification, and the need for additional or auxiliary interventions. Postoperative assessment of stone clearance was confirmed using plain X-ray KUB, and/or non-contrast CT KUB. A p-value of < 0.05 was considered statistical significance. Results: The two intervention groups were similar with respect to baseline demographic variables. The average stone diameter was greater among patients managed with LU (1.71 ± 0.29 cm) than those treated with URL (1.29 ± 0.31 cm), and this difference was statistically significant (p < 0.001). The mean operative time was longer in the laparoscopic ureterolithotomy group (101.2 ± 11.4 minutes) compared with the ureteroscopic lithotripsy group (40.9 ± 5.9 minutes), with this difference reaching statistical significance (p < 0.001).Postoperative hospitalisation was also prolonged in the LU group (2.5 ± 0.3 days) compared with the URL group (1.0 ± 0.3 days; p < 0.001). Stone clearance was complete in all patients undergoing LU, whereas the stone-free rate following URL was 78.6%, (p = 0.01). In the URL arm, 6 patients (21.4%) required additional treatment with PCNL, whereas none in the LU group required auxiliary intervention (p = 0.02). The majority of recorded complications were of low grade. Conclusion: Single-session laparoscopic ureterolithotomy is a better option than retreatment because it provides superior stone clearance and is unlikely to recur over time. Lithotripsy using the ureteroscopic approach is not as invasive and has faster healing, but has increased chances of leaving behind stones.