Comparison of ureteroscopic lithotripsy and laparoscopic ureterolithotomy in the treatment of large proximal ureteral stones in developing countries: a systematic review and meta-analysis

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BACKGROUND: Ureteral stones are common disorders of the urinary system, and larger proximal stones (>10 mm) often require surgical intervention due to their difficulty in passing naturally. The optimal surgical approach remains a matter of debate. This study compares the efficacy and safety of ureteroscopic lithotripsy (URSL) and laparoscopic ureterolithotomy (LU) for large proximal ureteral stones to inform clinical decisions. METHOD: A systematic review was conducted, encompassing randomized controlled trials (RCTs) from PubMed, Embase, Web of Science, Cochrane Library, and ResearchGate. RESULT: For our primary outcomes, LU demonstrated a significant benefit over URSL in terms of overall success rate, stone-free rate (SFR), initial SFR, SFR at 3 weeks, SFR at 1 month, and SFR at discharge, reducing the need for auxiliary treatment, lowering the residual calculi rate. LU significantly reduced the incidence of various complications. Specifically, among patients treated with LU, the occurrence of Clavien-Dindo Grade 2 and 3 complications is lower. Additionally, the incidence of mucosal injury, stone retropulsion, ureteral perforation, ureteral stenosis, and urinary tract infection is also lower in patients treated with LU. According to our subgroup analysis, both transperitoneal laparoscopic ureterolithotomy (TLU) and retroperitoneal laparoscopic ureterolithotomy (RLU) improved SFR, reduced the need for auxiliary treatment and stone retropulsion compared to URSL. CONCLUSION: Compared with URSL, LU demonstrates a higher SFR and fewer complications for patients with proximal ureteral stones larger than 10 mm.