Abstract
Objective To prospectively investigate the safety and efficacy of antegrade flexible ureteroscopy (FURS) with the following
criteria (supine, ultrasonic guided puncture through lower calyx with 14 fr tract, tubeless) versus retrograde intrarenal
surgery (RIRS) in the management of large impacted upper ureteric stones ≥ 1.5 cm.
Patients and methods This study recruited 61 patients with single large impacted upper ureteric stone of ≥ 1.5 cm. The
patients were randomly allocated to two groups. Group A, included 31 patients who treated by antegrade FURS, all patients
were put in supine modified galadako Valdivia position and the renal access is reached by ultrasonic guided puncture through
the lower calyx with dilatation upto 14 fr to insert ureteric access sheath and all cases were tubless with JJ stent insertion.
Group B, included 30 patients who were treated by RIRS with JJ stent insertion. Stone fragmentation was done by holmium
laser in both group.
Results Group A was significantly associated with higher proportion of SFR (90.3%) compared to Group B (70%) (p = 0.046).
Group B was significantly associated with shorter operative time and fluoroscopy time in comparison with Group A
(p < 0.001). No significant differences were found between studied groups regarding bleeding (p = 0.238). Urosepsis showed
significantly higher proportion associated with retrograde approach when compared to antegrade approach (p = 0.024).
Conclusion This study showed that antegrade FURS is safe and more effective than RIRS for the management of large
impacted upper ureteric stones ≥ 1.5 cm.