| Objective:To compare extracorporeal shockwave lithotripsy(SWL), rigid ureteroscopy (RURS),flexible ureteroscopy(FURS) and percutaneous nephrolithotomy(PCNL) and determine which technique was appropriate for proximal ureteral stones.Material and Methods:During six-year period,1275 patients with proximal ureteal stones were prospectively selected and assigned into groups of SWL,RURS,FURS and PCNL on the basis of patients’choice. Each group was allocated into three subgroups according to stone size,duration and dilated ureter diameter. Stone-free rate,recurrence rate and complication rate were analyzed.Results:Regarding stone-free rate in all the subgroups,RURS was higher than SWL while lower than FURS and PCNL(p<0.01).As for recurrence rate in all the subgroups,there’s no difference among RURS, FURS and PCNL(p>0.01), which were obviously lower than SWL(p< 0.01). When looking at complication rate,there’s no difference among them in the three subgroups of stone size< 1000mm3,duration<3months and dilated ureter diameter< 10mm (p> 0.05).In the subgroup of stone size≥1000mm3, RURS was higher than SWL,FURS and PCNL(p< 0.01).In the subgroup of duration≥3 months, SWL was higher than RURS,FURS and PCNL(p<0.01). In the subgroup of dilated ureter diameter≥10mm,FURS and PCNL was lower than SWL and RURS(p< 0.01).Conclusions:Stone size,duration and dilated ureter diameter should be taken into consideration to determine which approach was appropriate. SWL remained first-choice in the combination of stone size<1000mm3, duration< 3months and dilated ureter diameter<10mm. PCNL should be the most appropriate approach in the combination of stone size≥1000mm3, duration≥3months and dilated ureter diameter≥10mm. RURS should be the least preferred single approach for stone size≥1000mm3. SWL shouldn’t be recommended any more for duration≥3months alone. Recurrence rate could be obviously decreased through retrograde ureteroscopy and DJ ureteral stent placed. |
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