Conventionally, proximal ureteric stone is managed with stenting followed by a definitive treatment later. While distal and mid ureteric stones are deemed easy to be accessed using ureteroscope, proximal ureteric stone remains a challenge for most endourologists. This prospective, non- randomized, cohort study assessed the efficacy and safety of primary (P-URS) versus delayed ureteroscopy (D-URS) in the management of proximal ureteric stone.

A total of 176 consecutive patients with unilateral proximal ureteric stone >3mm were included in the final data analysis (95 P-URS and 81 D-URS). The decision to proceed with P-URS or D-URS was based on initial presentation and surgeon’s expertise. Stone free was defined as no visible residual fragments on the kidney, ureter and bladder (KUB) radiograph which was performed 6 weeks post-operatively. Primary outcome was stone free rate. Secondary outcomes included operative duration, length of hospital stay and rate of complications.

D-URS had a higher stone free rate (96.3%) compared to P-URS (74.7%) but overall operative duration, length of stay and rate of complications were comparable between these 2 groups. The most common unsuccessful reason for P-URS was retropulsion of stone (14.7%). All complications from D-URS were UTI-related (8.6%)

Primary URS for proximal ureteric stone is a safe and feasible option accepting the lower SFR compared to delayed URS. Primary URS should be attempted provided that the facilities and expertise are available.