Purpose To investigate the outcome and cost-effectiveness of ultrathin 6–7.5-Fr semirigid ureteroscopy in treating proximal
ureteric stones compared to flexible ureteroscopy.
Methods Two hundred and twenty patients with a solitary proximal ureteric stone were eligible for ureteroscopy (stone
size = 1–2 cm). Patients were randomly subdivided into two groups: Group I included 105 patients who underwent ultrathin
semirigid ureteroscopy and group II included 115 patients who underwent flexible ureteroscopy. Both groups were compared
regarding successful stone access, operation time, reoperation rates, the financial cost to stone-free, complications, and stone
clearance at 4 and 8 weeks.
Results Groups I and II had no significant differences regarding patient demographics, stone criteria, and hospitalization
time. In contrast, the mean operative time was significantly longer in group II (p < 0.001). The overall scope-to-stone access
rate was 89.5%. It was 87.6% compared to 91.3% (p = 0.32), while the stone-free rate was 81.9% versus 87.8% (p = 0.22) for
groups I and II, respectively. Intraoperative and postoperative complications were statistically insignificant between the study
groups. The cost/person in Egyptian pounds was 8619 ± 350 in group I, compared to 17,620 ± 280 in group II (p < 0.001);
similarly, the cost to attain the stone-free rate was 8950 ± 720 in group I compared to 17,950 ± 500 in group II.
Conclusion Ultrathin semirigid ureteroscopy is safe, durable, and considered a cost-effective method for treating upper ureteric
calculi compared to the flexible ureteroscopy and could be considered a first treatment option in developing countries.