Comparative study of simultaneous supine percutaneous nephrolithotomy with ureteroscopic lithotripsy and semi-rigid ureteroscopic lithotripsy in the management of large proximal ureteral calculi

Purpose: The aim of the study was to compare the outcomes of simultaneous supine percutaneous nephrolithotomy (sPCNL) with semi-rigid ureteroscopic lithotripsy (SR-URSL) (Group A) and SR-URSL (Group B) for treating large proximal ureteral calculus. Materials and Methods: Between January 2015 and April 2019, all patients with large proximal ureteral stones (≥10 mm) who underwent simultaneous sPCNL with SR-URSL or SR-URSL at three medical centers were retrospectively included. Two surgical options were provided based on patients and doctors' decision. The intraoperative and postoperative results, including operating time, hospital stay, need for auxiliary procedures, and complications, were compared between the two groups. Stone-free clearance was defined as the absence of fragments or a single fragment of ≤4 mm on standard radiography 1 month after surgery. Results: A total of 38 and 27 patients were included in Groups A and B, respectively. The mean stone size was 21 mm and 18.2 mm and stone-free rate (SFR) was 97% and 33% in Groups A and B, respectively. Larger ureteral stones (P < 0.001), longer operation time (P < 0.001), prolonged hospitalization (P < 0.001), higher SFR (P < 0.001), and less patients requiring auxiliary procedures (P < 0.001) were observed in Group A. No significant difference regarding complications was observed between groups (P = 0.1). Conclusion: Simultaneous sPCNL with SR-URSL is a feasible and effective treatment for large proximal ureteral stones. Even though larger stone size was observed, simultaneous sPCNL with SR-URSL results in significantly higher SFR and reduced need for auxiliary procedures, without major complications, compared to SR-URSL alone. More clinical studies are required to confirm the outcomes of the present study.