Comparative Analysis Of Three Minimally Invasive Lithotripsy For Treatment Of Complicated Ureteral Calculi

Objective: To compare the effect of the three types of endoscopic treatment to upperureteral calculi,the three types are ureteroscopy lithotripsy(URL), retroperitoneallaparoscopic ureterolithotomy(RLUL), percutaneous nephrolithotomy(PCNL).Toevaluate three methods of superiority and optimal indications.Methods: Research the the most important articles about the endoscopic treatment toupper ureteral calculi,and collect213cases using endoscopic treatment of upperureteral calculi,including58patients receive ureteroscopy lithotripsy,72patientsreceive retroperitoneal laparoscopic ureterolithotomy,and83patients receivepercutaneous nephrolithotomy.In strict accordance with the standard set, from all thechoose30cases of patients of three groups in random data for statistical analysis.Takeeach group of operative time, The value of hemoglobin decrease, the postoperativehospital stay, hospital cost, the postoperative calculi clearance rate, the incidence ofcomplications etc indexes were analyzed.Results:(1)The mean operation time of URL, PCNL and RLUL groups was34.63±3.67min,64.40±6.17min and61.30±5.72min.Statistical analysis showed theoperation time of URL group significant lower than PCNL group and RLUL group. Nosignificant difference in the other two groups.(2) The mean value of hemoglobindecrease was4.17±1.8g/L,20.67±3.43g/L and8.63±2.59g/L. Statistical analysisshowed the value of hemoglobin decrease of RLUL group lower than URL group,butsignificant lower than PCNL group（P＜0.01）.(3)The mean postoperative hospital stay was4.23±1.50ds,8.23±1.43ds and6.43±1.38ds. Statistical analysis showed thepostoperative hospital in RLUL group was obviously longer than that in URL group,but shorter than that in PCNL group（P＜0.01).(4) The mean hospital cost was5329±1531yuan,10259±2598yuan and13182±2177yuan.Statistical analysis showedthe hospital cost in RLUL group was obviously more than that in URL group,but lessthan in PCNL group（P＜0.01）.(5)It was considerd successful treatment that theresidual stone was less than4cm,when reviewing by the urinary ultrasound or KUBafter one week.Totally having4patients,s residual stone was larger than4mm in URLgroup.The4patients needed auxiliary extracorporeal shock wave lithotripsy(ESWL).The mean postoperative calculi clearance rate was86.6%，100%and100%. Statisticalanalysis showed the postoperative calculi clearance rate in PCNL group and RLULgroup was obviously more than in URL group.(6)In URL group,fever occurred intwo cases,but blooding, ureteral perforation and secondary to ureteral stenosis hadnot occurred.In PCNL group,fever occurred in two cases,and blooding occrurred intwo cases.In RLULgroup, leakage of urine only occurrde in one case,and subcutaneousemphysema occurred in one case. the incidence of complications in URL, PCNL andRLUL groups was6.67%,13.3%and6.67%. Statistical analysis showed the incidenceof complications had no significant difference(P＜0.05).Conclusion: Although the URL with shorter hospital stay, surgical trauma and otheradvantages,but produces poor effect in treatment.PCNL has good therapeutic effect andhigh clear stone,especially for the case of the difficult accesses with the ureteroscopyand the larger stones,but have higher postoperative complications.In thehospital,having mature technical condition,RLUL could replace open surgery,and maybecome the preferred choice to treat upper ureteral calculi.