الفهرس 
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Abstract
This prospective study aims to compare the clinical efficacy and safety of flexible ureteroscopy versus laparoscopic ureterolithotomy in the management of upper ureteric stones measuring from one to two centimeters.
The present study included a total of 56, medically fit patients, with upper ureteric stone, selected on OPD basis, admitted from Urology unit, Ain Shams University in the period from August 2020 till August 2022.
The patients were operated by a single expert team of surgeons. The results were collected and analyzed statistically based on the stone size, mean operative time, hospital stay (in days), success rate, stone free rate and complications.
They were divided into two groups; group A consists of 31 patients who underwent Flexible ureteroscopy (FURS) with holmium-YAG laser lithotripsy and group B consists of 25 patients who underwent Retroperitoneal Laparoscopic Ureterolithotomy (RPLU).
The present study of 25 patients showed a hospitalization time of 1.16 day in RPLU group.
So, as regards hospitalization time in our study there was no statistical significance between both FURS and RPLU groups (p-value 0.112).
As regards the mean stone size in our study was 15.84 ± 2.43 in RPLU group and 16.94 ± 2.21 mm in FURS group with no significant difference between both groups (P-value 0.083).
In our study, the mean operative time was calculated to be 82.60 ± 24.56 and 48.84 ± 7.96 min in and minutes in RPLU group and FURS group with significant difference (p-value 0.00) may be due to familiarity of endoscopic procedure and experienced hands in FURS.
In the present study, the mean blood loss intraoperative was observed to be 23.9 ± 7.35 ml FURS group and 70.96 ± 6.54 ml in RPLU group with significant difference between both groups (P-value 0.00). This difference was due to the nature of each procedure and the need of trocars insertion and intra-abdominal dissection.
In our study, The VAS score at 6 hours post-operative and day 1 post-operative was found to be 5.32 and 2.71 in FURS group and was found to be 7.28 and 3.28 in RPLU group respectively showing significant difference with (p-value <0.001 and 0.016 respectively) between the two groups with more satisfaction in FURS group mostly due to the absence of trocars incisions.
The complications were classified according to modified Clavien classification system. No major complications such as septic shock or death were reported in either treatment groups.
In the present study, the intraoperative ureteric mucosal injury was found to be 2 out of 31cases (2/31) (6.5%) in FURS group and 0 out of 25 cases (0/25) (0.0%) in RPLU group.
In our study, The Stent related discomfort in postoperative and follow up periods were found to be 3/31 (9.7%) in FURS group and 2/25 (8.0%) in RPLU group with no significant difference (P-value 0.827).
The intraoperative ureteric Perforation in our study was found to be 2/31 (6.5%) in FURS group and 0/25 (0.0%) in RPLU group with no significant difference (P-value 0.196).
The postoperative fever was found to occur in 3/31 (9.7%) in FURS group and 2/25 (8.0%) in RPLU group with no significant difference (P-value 0.827).
As regards the recovery to work in postoperative and follow up periods in the present study, there was a significant difference between both groups with (P-value <0.001), as we found that it takes about 4.56 ± 0.82 days in RPLU group and 3.06 ± 1.91 days in FURS group to return daily routine activities.
As regards the stone free rate in follow up periods in the present study, there was a significant difference between both groups with (P-value 0,02), as we found that it was 100% and 80,6% in RPLU and FURS group respectively.
Our success rate in RPLU group was found to be 100% in comparison to Irfan Nazir Mir et al which was 93.4% (28/30) with two patients (2/30) converted to open ureterolithotomy, either due to technical snag or due to difficulty in localizing the ureter laparoscopically.