Comparative Study Of Three Minimally Invasive Means Of Treatment For Ureteral Calculi Between The Fourth And Fifth Lumbar Vertebrae

Objective To analyze the advantages and disadvantages, and indications of threeminimally invasive surgical methods in deal with the ureteral calculi between the fourth andfifith lumbar vertebrae.To explore the role and advantages of the means combination ofpercutaneous nephrostomy and transurethral ureteroscopy in deal with the ureteral calculibetween the fourth and fifith lumbar vertebrae.Methods89cases who is suffering from the ureteral calculi between the fourth andfifith lumbar vertebrae since June2010to December2011in Urology Surgery of HebeiUniversity affiliated Hospital.All patients were according to preoperative imaging, a fullassessment of surgical risk and difficulty,respectively treated by URL MPCNL andcombination of percutaneous nephrostomy and transurethral ureteroscopy.In which35caseswho cured by URL,for the surgery group of URL;33cases who cured by MPCNL, for thesurgery group of MPCNL;21cases who cured by combination of percutaneous nephrostomyand transurethral ureteroscopy,for for the surgery group of combination of percutaneousnephrostomy and transurethral ureteroscopy.Retrospective analysis of the the efficacy andsafety indicators among the three groups in the success rate on one session, the stone-free rate,Efficiency quotient(EQ), operative time, mean postoperative hospital stay, blood loss,complication rate.Application of completely randomized analysis of variance, the applicationof LSD-t-test, counting material used chi-square test, P <0.05for with a statisticalsignificance.Results The differences were no statistically significant (P>0.05) between the threegroups in the operation time;the differences were statistically significant (P <0.05) betweenthe three groups in the mean postoperative hospital stay, the surgery group of URL less thanthe other two groups, but there was no significant difference between the other two groups(P>0.05); there was no significant difference between the three groups in stone-free rate aftersurgery(P>0.05); the EQ of the three groups respectively were0.77,0.83,0.95; the differenceswere statistically significant (P <0.05) between the three groups in the Intraoperative bloodloss, the surgery group of URL less than the other two groups, but there was no significantdifference between the other two groups(P>0.05); there was no significant differencebetween the three groups(P>0.05) in the postoperative complication incidence. Conclusions1. The surgical methods of URL have a higher stone-free rate,and therewas an obvious advantage in the postoperative hospital stay and intraoperative blood loss Indeal with the ureteral calculi between the fourth and fifith lumbar vertebrae, can be used asthe primary surgical treatment.2. The surgical methods of MPCNL with a high stone-free rateand a lower incidence of complications, Can be used as an effective surgical treatment for theureteral calculi between the fourth and fifith lumbar vertebrae, especially can be used as agood adjuvant therapy for the treatment failure in patients by URL.3. The surgical methods ofcombination of percutaneous nephrostomy and transurethral ureteroscopy has a high stoneclearance rate, while the incidence of complications is not higher than the other two surgicalmethods, can be used as a safe and effective ideal remedy surgical methods for the part ofrefractory ureteral calculi between the fourth and fifith lumbar vertebrae which failed treatedby both URL and MPCNL.