Comparison And Selection Of Minimally Invasive Surgical Treatment For Upper Ureteral Calculi

Objective To compare the efficacy of four kinds of minimally invasive surgery,including URSL),PCNL,RIRS and RLUL in the treatment for the patients with upper ureteral calculi.Methods 319 Cases of upper ureteral calculi were treated with minimally invasive surgery,including 126 cases in URSL group,115 cases in PCNL group,30 cases in RIRS group and 48 cases in RLUL group.The success rate of treatment,stone clearance rate,serious complications,operative time,hospitalization days,treatment cost,stone recurrence rate at 6 months after surgy and the incidence of ureteral stenosis at 6 months after surgy were observed.Results Compared with the URSL group,the success rate of one-time operation and the removal rate of stones in the other groups were significantly higher(P<0.05).There was no significant difference about the success rate of one-time operation and the removal rate of stones among all groups except URSL group(P>0.05).There was no significant difference in the incidence of serious complications among all groups(P>0.05).Compared with the URSL group,the operative time and the cost of treatment in the other groups were significantly higher(P<0.05).Compared with the PCNL group,the operative time and the cost of treatment in RLUL group were significantly lower(P<0.05).Compared with the URSLgroup and the RIRS group,the hospitalization days was significantly higher in PCNL group and RLUL group(P<0.05).Compared with the URSL group,the hospitalization days in RIRS group was significantly lower(P<0.05).There was no significant difference in the hospitalization days between the PCNL group and the RLUL group(P>0.05).Compared with the URSL group,the stone recurrence rate at 6 months after surgy in the other groups were significantly lower(P<0.05).There was no significant difference about the stone recurrence rate at 6 months after surgy among all groups except URSL group(P>0.05).There was no significant difference about the incidence of ureteral stenosis at 6 months after surgy among all groups(P>0.05).Conclusion There were some advantages and disadvantages in these four kinds of minimally invasive surgery respectively.The clinical doctors may choose the appropriate treatment according to the specific circumstances of the hospital and the patient's own needs.RIRS is the first chorce in combination with trauma and success rate.The primary hospital is limited by the equipment,we can first consider the URSL treatment of upper ureteral calculi,should cooperate with the application of stone blocking devices.If the stone load is too large,or with severe hydronephrosis,and PCNL technology mature,PCNL may be preferred,but also further m PCNL,UMP,SMP.The laparoscopic technology mature processing unit,long time incarcerated ureteral calculi,can be considered for RLUL,at the same time with the ipsilateral adrenal or kindney disease,such as adrenal adenoma or simple renal cyst,operation effect is better.