Outcome of Push-Back and Percutaneous Nephrolithotomy in Comparison to Laparoscopic Ureterolithotomy for the Treatment of Upper Ureteric Stone

Objective: The present study compared the safety and efficacy of push-back and percutaneous nephrolithotomy (PCNL) and laparoscopic ureter lithotomy (LU) for the treatment of upper ureteric stone.

Materials and Methods: The study was prospective observational study. Total 40 patients equally divided in two groups who underwent push-back and percutaneous nephrolithotomy (group A) and laparoscopic ureterolithotomy (group B) at Dhaka Medical College Hospital, Dhaka and National Institute of Kidney
Diseases and Urology, Dhaka from October 2020 to March 2021. Patient demographics, stone size and procedure related parameters including stone clearance rate, operation time and hospital stay after surgery, pain score and complications rate were compared between groups A and B.

Result: Results of this study showed that both procedures were effective for removing upper ureteric stone. Mean stone size was 1.09 ± 0.23 in group A and 1.28 ± 0.24 in group B. Difference between the stone sizes were significant (p= 0.004) between the groups. The stone free rate after a single procedure was 85% in group A and 95% in group B (p= 0.292). The operation time was longer in group B than in group A (109 ± 15.7 min versus 84.7± 16.1 min, p= < 0.001) which was significant. Significant difference was also observed between the groups with respect to the length of hospital stay after the surgery (3.7 ± 0.98 days versus 4.95 ± 0.60 days in group A and group B). The mean pain scores obtained at 24 hours (8.0 ± 1.45 versus 6.55 ± 2.04, p=0.013) were significantly higher for group A than for group B. Complications between the two groups were insignificant.

Conclusion: These results indicate that both procedures are suitable for removing upper ureteric stone and are associated with a high rate of patients being stone free afterwards. Despite higher post operative pain score, push-back and percutaneous nephrolithotomy associated with less procedural time and less post operative hospital stay. However, the choice of treatment depends on the preferences of surgeons and patients.

Keywords: Upper Ureteric Stone, Percutaneous Nephrolithotomy (PCNL), Push-Back Technique, Laparoscopic Ureterolithotomy, Minimally Invasive Surgery, Stone Clearance, Urolithiasis.