| Objective:To evaluate the clinical efficacy and safety of ureteroscopic lithotripsy (URL) and minimally invasive percutaneous nephrolithotomy (m-PCNL) for the one-stage treatment of complex upper ureteral calculi.Materials and Methods:Data of 216 patients with complex upper ureteral calculi treated by URL or m-PCNL from October 2006 to December 2009 in our hospital were analyzed retrospectively. Here were 121 males and 95 females patients whose average age was 43.2.15-72 years old patients were treated by URL and m-PCNL according to random selection procedure. The operations were done by two associate chief physician. The success rate, operation time, blood loss, residual stone rate, the average postoperative hospital stay and hospital costs were assessed and compared between two groups after surgery.Results:Among 216 patients,128 cases were diagnosed with left ureteral stones, and 88 cases with right ureteral stones,29 cases with ipsilateral kidney stones,37 patients with contralateral kidney stones,27 cases with lower ureteral stones,38 cases with renal dysfunction. Preoperative clinical data of two groups of patients were analyzed by student t test, and the difference was not statistically significant (P>0.05). In 112 patients performed by URL, the operation was successful in 82 cases, with a surgical success rate 73.21%; the success rate of m-PCNL group which contained 104 cases was 85.57%. Operation time:URL 39.20±7.50min, m-PCNL 117.60±14.30 minutes; stone clearance rate: URL 72.46%, m-PCNL 88.68%, intraoperative blood loss:URL 22.5±3.30ml, m-PCNL155.70±6.50 ml. Hospitalization time:URL 3.37±1.36days, m-PCNL 6.25±1.63 days; hospital charges:URL 4318.78±123.33 yuan, m-PCNL 6726±150.37 yuan. All indicators between two groups were analyzed by student t test and we found that URL group's operation time, blood loss, postoperative hospital stay and hospital charges were less than m-PCNL group (P＜0.05), while the m-PCNL group of the success rate of surgery and the rate of stone clearance were higher than the URL group (P<0.05). Stones of 23 patients in URL group had returned to the renal collecting system during operation, which consisted of 15 cases of stones above the upper edge of the second lumbar vertebrae,6 cases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae,2 cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest. Success rate of URL group among different locations had significant difference by using chi-square test (χ2=6.41, P<0.05). Stones of 11 patients in m-PCNL group had moved to the lower part of ureteral, which consisted of one cases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae, 6 cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest. Success rate of m-PCNL group among different locations had significant difference by using chi-square test (χ2=7.11, P <0.05).Conclusion:The URL, in the operation time, blood loss, postoperative hospital stay and hospital charges, is better than m-PCNL. On the other hand, the success rate of surgery, the rate of stone clearance of URL are worse than m-PCNL. The closer the location of stones near the renal pelvic, the higher success rate of m-PCNL and failure rate of URL; The closer the location of stones near the lower part of ureteral, the higher success rate of URL and failure rate of m-PCNL. The treatment should be selected based on the comprehensive evaluation of the general condition of patients, stone location, renal function and economic status. |
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