الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
There is a Considerable debate regarding the optimal therapeutic approach for large proximal ureteral stones. The optimal therapy for LPUS depends on several factors including safety, efficacy, resources, surgeon experience, recovery time and cost. These make our concern to be raised regarding which is more effective and safer in the management of large proximal ureteral stones. Therefore, we aimed in the current study to comprehensively evaluate and to compare the outcome of transperitoneal laparoscopic ureterolithotomy, retrograde ureteroscopy and mini-percutaneous antegrade ureteroscopy for management of large proximal ureteric stone (15 -20 mm) with regards to; operative time, stone free rate, success rate, hospital stay and complications. A total of 105 participants were enrolled in the trial between April 2021 and June 2023 to accomplish this. Inclusion criteria for this study included patients who had a single proximal Ureteral stone (between the pelvi ureteric junction and the upper border of the sacroiliac joint) measuring 15-20 mm in diameter. Patients with a history of open abdominal surgery, uncorrectable coagulopathy, and congenital anomalies of the kidney, such as horse-shoe kidneys and ectopic pelvic kidneys, were also excluded, as were those with multiple ureteric stones, elevated serum creatinine, active UTI, or with associated renal stones. Patients were randomly allocated to receive either TPLU, RURS, or Minin-perc Antegrade URS, with a 1:1:1 allocation ratio. After providing informed permission, the patients were randomly assigned to one of three groups: group I (35 patients treated with TPLU), group II (35 patients treated with RURS), and group III (35 patients not treated with either TPLU or RURS) (Included 35 patients who were treated by Mini-perc Antegrade URS) Except for the mean surgical time, which was considerably shorter for patients in the RURS group than in the patients included in the other two groups (P .0001), all preoperative, intraoperative outcomes, and complications were similar across the three groups. However, there was a statistically significant difference between the antegrade and retrograde groups as regard Hb deficit, with the antegrade group having a higher Hb deficit but not requiring transfusion. In addition, the laparoscopy group had a 100% stone-free rate, while the antegrade group had a 91% rate, and the retrograde group had an 80% rate. Finally, the need for an auxiliary procedure (ESWL or URS) to treat the stone was higher in the retrograde group (25.7% of cases) than in the antegrade group (17.1% of cases). Except for two occurrences of ileus in the laparoscopic group and one incidence of urosepsis in each of the antegrade and retrograde groups, there was no statistically significant difference between the groups in terms of postoperative complications and events. Additionally, the antegrade group had a somewhat longer postoperative hospital stay and convalescence than the other two groups.