Efficacy of Semirigid Ureteroscopy in the Management of Upper Ureteric Stones in a Resource-Limited Hospital: A Prospective Observational Study

Abstract Background Upper ureteric stone disease is a prevalent urological condition that demands timely intervention. In resource-limited hospitals, access to flexible ureteroscopy (fURS) and holmium:yttrium-aluminum-garnet (Ho:YAG) laser systems is often unavailable due to prohibitive costs and fragility of equipment. Semirigid ureteroscopy (SR-URS) remains the most accessible and durable endoscopic modality in such settings. This study evaluates the efficacy and safety of SR-URS for the management of upper ureteric stones in a resource-limited hospital. Methods This prospective observational study was conducted at a resource-limited secondary-level hospital. A total of 185 consecutive patients with upper ureteric stones (size 1.2–2.0 cm) were enrolled between January 2022 and December 2024. All procedures were performed with a semirigid Karl Storz ureteroscope using pneumatic lithotripsy and/or holmium laser. The primary outcome was stone-free rate (SFR) at four weeks. Secondary outcomes included operative time, perioperative complications classified by the Clavien-Dindo system, and need for a second-look procedure. Results The mean patient age was 45.2 ± 14.6 years (range 20–76). Males constituted 56.2% (n = 104) of the cohort. Mean stone size was 1.66 ± 0.20 cm. The SFR at four weeks was 98.4% (182/185). Mean operative time was 23.3 ± 10.2 minutes. The overall complication rate was 24.9% (n = 46); all complications were Clavien-Dindo grade I–II. The most common complications were mucosal injury (18.9%), false passage (18.9%), and intraoperative bleeding (11.9%). Stone migration occurred in 2.7% of cases. Three patients (1.6%) required a second-look procedure. No ureteral perforations occurred. Conclusions Semirigid ureteroscopy achieves an excellent stone-free rate of 98.4% with an acceptable safety profile in a resource-limited hospital setting. SR-URS should be considered the standard first-line treatment for upper ureteric stones in institutions where flexible ureteroscopy is unavailable or unaffordable.