Erping Wang, Peng Tang, Chen Chen
Laparoscopic ureterolithotomy provides higher stone-free rates and fewer complications for large proximal ureteral stones, but entails longer operative time, extended hospitalization, and increased postoperative pain. However, the pooled estimates predominantly derive from older trials lacking contemporary ureteroscopic technologies (e.g., high-power lasers, suction access sheaths). Thus, laparoscopic ureterolithotomy represents a viable alternative primarily where modern ureteroscopic equipment is unavailable or contraindicated.
PURPOSE: Large proximal ureteral stones (>1 cm) present significant therapeutic challenges due to high complication risks and technical complexities. Current guidelines provide no clear preference between ureteroscopic lithotripsy and laparoscopic ureterolithotomy for large proximal ureteral stones, and the optimal surgical approach remains debated. This meta-analysis therefore compares the clinical efficacy and safety of ureteroscopy versus laparoscopic ureterolithotomy using randomized controlled trial (RCT) data.
MATERIALS AND METHODS: We systematically searched PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and China Biomedical Literature Database from their inception to July 12, 2026, for RCTs comparing the clinical efficacy of ureteroscopy and laparoscopic ureterolithotomy for large proximal ureteral calculi (>1 cm). Data from the included RCTs were statistically analyzed using Review Manager 5.2 software.
RESULTS: A total of 11 RCTs involving 1300 patients were included. Laparoscopic ureterolithotomy showed significantly higher immediate (odds ratio [OR] = 8.06, P < .001) and final (OR = 8.56, P < .001) stone-free rates, but longer operative time (standardized mean difference [SMD] = 1.28, P = .01), longer hospital stay (SMD = 1.67, P < .001), and higher postoperative pain scores (SMD = 0.76, P < .001) compared with ureteroscopy. Postoperative complication rates were significantly lower with laparoscopic ureterolithotomy (OR = 0.43, P < .001).
CONCLUSION: Laparoscopic ureterolithotomy provides higher stone-free rates and fewer complications for large proximal ureteral stones, but entails longer operative time, extended hospitalization, and increased postoperative pain. However, the pooled estimates predominantly derive from older trials lacking contemporary ureteroscopic technologies (e.g., high-power lasers, suction access sheaths). Thus, laparoscopic ureterolithotomy represents a viable alternative primarily where modern ureteroscopic equipment is unavailable or contraindicated.