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Objective <p>To compare efficacy and safety of antegrade flexible ureteroscopic lithotripsy (fURSL) in treating proximal ureteric stone ˃ 10 mm in maximum diameter including impacted stones with the retrograde approach.</p> Patients and materials <p>This randomized prospective comparative study conducted at high-volume hospitals in urology departments in Ain Shams university and Theodor Bilharz Research Institute from March 2022 to December 2025 and included 100 patients all having upper ureteric stone larger than 10 mm (˃10 mm) in maximum diameter. Patients were randomized into 2 groups; the antegrade fURSL (group A) and retrograde fURSL (group B). For stone disintegration flexible ureteroscope and holmium laser were used . Renal access tract was achieved in antegrade group in prone position. All patients had double J stent fixed at end of procedure.</p> Results <p>Group A patients had higher stone-free-rate (SFR) than group B (92% Vs 74%) showing statistical significance (P = 0.027). This gap in SFR increases with focusing on subgroups of impacted stones (94.12% Vs 64.5%, P = 0.004). Group B patients required a significantly higher proportion of auxiliary treatment (18% Vs 4%, P = 0.02). Group B had significantly shorter operative and fluoroscopy times than group A (P &lt;0.0001) and had significantly shorter hospital stay (P = 0.015). Mean hemoglobin drop in group A was higher than in group B with no statistical significance, no signs of bleeding were recorded nor the need for blood transfusion. Overall complications were higher in group B than in group A (P = 0.028). Complications rate was significantly related to failure of insertion of ureteral access sheath (UAS) in retrograde approach with odds ratio 14.7.</p> Conclusion <p>Antegrade fURSL is safe and effective modality to treat upper ureteric stones ˃10 mm mm in maximum diameter with higher SFR, less auxiliary procedures needed and favorable post-operative adverse events profile. Antegrade approach efficacy is augmented when focusing on treating impacted stones.</p> Clinical trial registration <p>ClinicalTrials.gov ID&#xa0;NCT07362784.</p>

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Efficacy and safety of antegrade ureteroscopic lithotripsy versus retrograde ureteroscopic lithotripsy in the treatment of upper ureteric stones measuring > 10 mm in maximum dimension and/or impacted stones: randomized comparative study

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Mohamed Wishahi,
  • Mohammad Attaby,
  • Rafik El Halaby,
  • Ahmad G. Elbaz,
  • Mohamed Hasan

摘要

Objective

To compare efficacy and safety of antegrade flexible ureteroscopic lithotripsy (fURSL) in treating proximal ureteric stone ˃ 10 mm in maximum diameter including impacted stones with the retrograde approach.

Patients and materials

This randomized prospective comparative study conducted at high-volume hospitals in urology departments in Ain Shams university and Theodor Bilharz Research Institute from March 2022 to December 2025 and included 100 patients all having upper ureteric stone larger than 10 mm (˃10 mm) in maximum diameter. Patients were randomized into 2 groups; the antegrade fURSL (group A) and retrograde fURSL (group B). For stone disintegration flexible ureteroscope and holmium laser were used . Renal access tract was achieved in antegrade group in prone position. All patients had double J stent fixed at end of procedure.

Results

Group A patients had higher stone-free-rate (SFR) than group B (92% Vs 74%) showing statistical significance (P = 0.027). This gap in SFR increases with focusing on subgroups of impacted stones (94.12% Vs 64.5%, P = 0.004). Group B patients required a significantly higher proportion of auxiliary treatment (18% Vs 4%, P = 0.02). Group B had significantly shorter operative and fluoroscopy times than group A (P <0.0001) and had significantly shorter hospital stay (P = 0.015). Mean hemoglobin drop in group A was higher than in group B with no statistical significance, no signs of bleeding were recorded nor the need for blood transfusion. Overall complications were higher in group B than in group A (P = 0.028). Complications rate was significantly related to failure of insertion of ureteral access sheath (UAS) in retrograde approach with odds ratio 14.7.

Conclusion

Antegrade fURSL is safe and effective modality to treat upper ureteric stones ˃10 mm mm in maximum diameter with higher SFR, less auxiliary procedures needed and favorable post-operative adverse events profile. Antegrade approach efficacy is augmented when focusing on treating impacted stones.

Clinical trial registration

ClinicalTrials.gov ID NCT07362784.