A prospective randomized comparative study of retroperitoneoscopic and endourological approaches for upper ureteric and renal pelvic calculi (1.5–2.5 cm)

Background: Upper ureteric and renal pelvic calculi can be managed using endourological, laparoscopic, open, or retroperitoneoscopic techniques. Retroperitoneoscopy enables stone extraction while avoiding peritoneal violation. This study compares the outcomes of retroperitoneoscopic and endourological approaches for stones measuring 1.5–2.5 cm. Methods: Sixty patients with renal pelvic or upper-third ureteric calculi (1.5–2.5 cm) were randomized into two groups: Group A: retroperitoneoscopic ureterolithotomy/pyelolithotomy and Group B: ureteroscopic lithotripsy/retrograde intrarenal surgery. Primary outcomes included operative time, hospital stay, stone-free rate, and postoperative complications (Clavien–Dindo). Stone-free status was assessed using NCCT KUB on day 3. Results: Group A achieved significantly higher mean clearance rates (99.5% ± 1.2% vs 93.2% ± 4.5%) and fewer overall complications (20% vs 30%). Group B demonstrated shorter operative time (48.3 ± 3.6 vs 74.2 ± 4.1 minutes; p < 0.001) and shorter hospital stay (1.4 ± 0.5 vs 1.9 ± 0.6 days; p < 0.01). All complications were Clavien–Dindo grades I–II. Conclusion: Retroperitoneoscopic surgery provides superior stone clearance with a favorable safety profile, although this is achieved at the expense of longer operative duration. Endourology offers faster surgery and shorter hospitalization, but lower one-session clearance. Surgical choice should be individualized based on stone characteristics and patient factors.