Ureteropelvic junction (UPJ) stones often require surgical intervention. Ureterorenoscopic Stone Manipulation (URSSM), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL) are common treatment modalities. This study aimed to compare the efficacy and safety of these three surgical approaches.

We conducted a single-center retrospective cohort study (January 2020–December 2024) on 70 patients with isolated UPJ stones (no concurrent renal stones) treated with URSSM (n=38), RIRS (n=19), or PCNL (n=13). Data included demographics, comorbidities (diabetes mellitus, chronic kidney disease), stone size (largest diameter or sum of the largest diameters for multiple stones), stone characteristics, perioperative outcomes, operative time, and stone-free rate (SFR, no residual stones >4mm on KUB) at day 1 and 1 month. Hospital stay, complications, and re-intervention rates were also analyzed.

Preoperative characteristics were comparable, except for sex (male) (p = 0.0004) and stone size, which was largest in PCNL, followed by RIRS and URSSM (p = 0.003). Operative time differed significantly (p = 0.0004), with PCNL being the longest, followed by RIRS and URSSM. No significant differences were observed in intraoperative complications, postoperative complications, hospital stay, or SFR at 1 day. The SFR at 1 month differed significantly (p = 0.048), highest in RIRS, followed by PCNL and URSSM. The need for re-intervention also showed a significant difference (p = 0.023), being highest in URSSM, followed by PCNL and RIRS.

PCNL required the longest operative time but had a high SFR and low re-intervention rate, making it suitable for larger stones. RIRS achieved the highest 1-month SFR with no re-intervention. URSSM, though the shortest in duration, had the lowest SFR and highest re-intervention rate. These findings emphasize treatment selection based on stone characteristics, efficiency, and re-intervention risk, providing insights for surgical decision-making.