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Evaluation of ultrathin semirigid ureteroscopy in terms of efficiency and cost compared to flexible ureteroscopy in treating proximal ureteric stones: a prospective randomized multicenter study

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Abstract

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.

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Availability of data and materials

Data sets used in this study are available upon reasonable request from the corresponding author.

Abbreviations

ESWL:

Extracorporeal shock wave lithotripsy

URS:

Ureteroscopy

F-URS:

Flexible ureteroscopy

KUB:

Kidney, ureter, and bladder

US:

Ultrasound

CTUT:

Computerized tomography of the urinary tract

LASER:

Light amplification by stimulated emission of radiation

MCCS:

Modified Clavien classification system

EGP:

Egyptian pounds

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Authors and Affiliations

  1. Urology Department, Faculty of Medicine, Benha University, Benha, Egypt

    Tarek Mohamed Gharib & Amr S. El-Dakhakhny

  2. Urology Department, Najran Armed Force Hospital, Najran, Saudi Arabia

    Tarek Mohamed Gharib

  3. Urology Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Asyût, 71511, Egypt

    Ibrahim Abdel-Al

  4. Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Adel Elatreisy, Mahmoud Faisal & Osama Shalkamy

Authors
  1. Tarek Mohamed Gharib
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Contributions

All listed authors (TMG, IA, AE, MF, OS and ASE) performed substantial contributions to conception and design, methodology, acquisition of data, or analysis, review, and interpretation of data.

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Correspondence to Ibrahim Abdel-Al.

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Gharib, T.M., Abdel-Al, I., Elatreisy, A. et al. Evaluation of ultrathin semirigid ureteroscopy in terms of efficiency and cost compared to flexible ureteroscopy in treating proximal ureteric stones: a prospective randomized multicenter study. World J Urol 41, 2527–2534 (2023). https://doi.org/10.1007/s00345-023-04507-8

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