‘Boxing in the corner’: A modified retrograde approach for the management of proximal ureteric stones of 1–2 cm
Objectives : To study a modification to the conventional retrograde ureteroscopic approach for treating proximal ureteric stones of 1–2 cm; we intentionally push the stone from the proximal ureter into a favourable calyx then the flexible ureteroscope is used to fragment the trapped stone using lase...
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| Published in: | Arab journal of urology Vol. 19; no. 2; pp. 141 - 146 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Taylor & Francis
03-04-2021
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Objectives
: To study a modification to the conventional retrograde ureteroscopic approach for treating proximal ureteric stones of 1–2 cm; we intentionally push the stone from the proximal ureter into a favourable calyx then the flexible ureteroscope is used to fragment the trapped stone using laser lithotripsy (‘boxing in the corner’).
Patients and methods
: The study was conducted in a randomised prospective manner and included 100 patients who presented with a single proximal ureteric stone of 1–2 cm. We randomised the patients into two equal groups: Group A (50 patients) underwent the conventional retrograde technique (CRT) and Group B (50 patients) underwent the modified retrograde technique (MRT) with the primary intention of relocating the stone into a favourable calyx. Intended relocation of the proximal ureteric stone in the MRT group was achieved in a stepwise manner. All intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.
Results
: There was no statistical significant difference in terms of the patients’ demographics and stone criteria between the two groups. The stone-free rate (SFR) was significantly higher in Group B (92%) compared to Group A (78%) (
P
= 0.049). Fluoroscopy time was significantly longer in Group B (
P
< 0.001), while operative time, lithotripsy time and hospital stay were comparable. There was no difference between the groups regarding complications.
Conclusion
: The MRT was found to be safe and more effective than the CRT for treating proximal ureteric stones of 1–2 cm, with a significantly higher SFR.
Abbreviations
CONSORT: Consolidated Standards of Reporting Trials; ESWL: extracorporeal shockwave lithotripsy; fURS: flexible ureteroscope; NCCT: non-contrast CT; SFR: stone-free rate; YAG: yttrium-aluminium-garnet |
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| ISSN: | 2090-598X 2090-5998 |
| DOI: | 10.1080/2090598X.2021.1881421 |