Comparison Of Four Methods For Treating Complex Stones In Upper Ureter

Objective:To use extracorporeal shock wave lithotripsy(ESWL),ureteroscopic lithotripsy(URL),microsurgery percutaneous nephrolithotomy lithotripsy(MPCNL)and laparoscopic ureteral diversion for 165 cases of complicated ureteral calculi in our hospital.The comparison of the effects of RLU treatment and summarizing the optimal treatment of complex stones in the upper ureter.Methods:From April 2015 to December 2017,we used ESWL,URL,MPCNL,and RLU to treat 165 patients with complicated upper ureteral stones.Each treatment group received one treatment success rate and operative time according to the treatment results.Stone clearance rates(including 1 week,January,and March),postoperative hospital stay,hospital costs,bleeding,and complications were compared.Results:1.The success rate of one-time treatment: The success rate of one-time treatment in the ESWL group,URL group,PCNL group,and RLU group was 66.7%,81.6%,100%,and 100%,respectively.By comparison between the two groups,except for the MPCNL group and the RLU group,there was a significant difference between the other groups(P < 0.05).2.Operative time: Statistical analysis showed that the operation time in the ESWL group was significantly shorter than that in the URL group,MPCNL group,and RLU group,and the P value was less than 0.01.3.Comparison of stone clearance rate: The stone clearance rate was compared as follows: RLU> MPCNL> URL> ESWL.Statistical analysis showed that the stone clearance rate in MPCNL group and RLU group was significantly higher than that in ESWL group(P<0.01).The stone clearance rate in the RLU group was significantly higher than that in the URL group(P<0.01).However,there was no significant difference between the URL group and the MPCNL group.There was no significant difference between the ESWL group and the URL group(P>0.01).One month after surgery,the difference between the groups was same as one week after surgery.There was no significant difference between the groups except ESWL and RLU at 3 months after operation(P>0.01).4.Postoperative hospital stay: Statistical analysis showed that hospitalization time in ESWL group was shorter than the other three groups,and the P value was less than 0.01.5.Hospitalization costs: Statistical analysis showed that the cost of hospitalization in the MPCNL group was significantly higher than the other three groups,and the P value was less than 0.01.6.Bleed volume: According to statistical analysis,the bleeding volume in the RLU group was lower than that in the MPCNL group,but it was significantly higher than that in the ESWL group and the URL group(P <0.01).Conclusions:1.ESWL is easy to operate,quick in treatment time,less painful,less complications,stones with low stone density,and no distal flexion and stenosis,which can be considered first.Some of the upper ureteral stones after ESWL treatment can be converted into lower and middle ureteral calculi,and then a feasible URL to take stone.Overall,the stone clearance rate of this operation is low.2.The characteristic of URL is not to attack a knife and cure stones.This type of surgery requires simple equipment,easy to learn,easy to operate,less damage to the body during surgery,low hospitalization costs,quick recovery of the body after surgery,for the treatment of ureteral polyposis in the merger can be a treatment.The success rate of one treatment was slightly worse than MPCNL and RLU.3.MPCNL surgical trauma is slightly larger,the success rate of a treatment and stone clearance rate is high,but this type of operation requires the hospital to have the appropriate stone removal equipment,the surgeon also has to master the surgical skills,for the presence of the same side of the kidney stones and renal pelvis Patients with narrow ureteropelvic junctions can undergo one-stage surgery and have a long hospital stay.4.RLU has the advantages of high success rate of treatment and high rate of stone clearance.However,it requires the surgeon to master laparoscopic techniques.The learning curve is long,the operation is relatively difficult,and the trauma is larger than URL and MPCNL.5.Clinicians should be based on different characteristics of the case flexible selection of ESWL,URL,MPCNL,RLU four minimally invasive surgery for the treatment of complex upper ureteral stones,with less trauma,high safety,fewer complications,and rapid recovery.Lower ureteral stones with relatively lower ureteral dilation may first use ESWL or URL.If the diameter of the stone is too large,the length of the urinary catheter is longer,or the ureter is severely dilated,the MPCNL or RLU may be the first choice,or the URL may be tried first.The loser is switched to MPCNL or RLU in the first phase.By comparison,MPCNL is better.RLU can be used as a remedy.Clinical considerations should be based on the patient’s general condition,treatment willingness,treatment costs,hospital equipment,doctors technical level and other aspects to consider and formulate the best treatment plan.