Therapeutic Effect Of Flexible Ureteroscopic Lithotripsy And NTrap Ureteroscopic Lithotripsy For Upper Ureteral Calculi

Objective: To compare the efficacy of flexible ureteroscopic lithotripsy(FURL)and NTrap ureteroscopic lithotripsy(NTrapURL)in the treatment of upper ureteral calculi,and to guide the clinical decision-making.Methods:We retrospectively evaluated 243 patients who underwent unilateral ureteral calculi at our center betwen January 2012,and March,2018,including 74 FURL patients and 169 NTrapURLpatients.Gender,age,course of disease,stonesside,stone size,stone hardness,hydronephrosis,preoperative indwelling double J ureteralcatheter,operation time,intraoperative stone moving up,postoperative immediate meaningless residual stone,postoperative hospitalstay,surgery cost,stone-freerateafter one month,intraoperative and postoperative complications(including pain,hematuria,fever,ureteral stenosis,etc.),postoperative double J ureteral catheterindwelling time,hydronephrosis improvement rate,postoperative stone recurrencewere recorded.Two surgical methods were analyzed.Results: There was no significant difference of gender,age,course of disease,stonesside,stone size,stone hardness,hydronephrosis,and preoperative indwelling double J ureteralcatheter between the two surgical patients(P>0.05).The operation time(31.08 ±13.29 min vs.33.49 ± 12.10 min.P = 0.582)showed no significant difference.The FURL group had significantly higher intraoperative stone removal rate(87.8% vs.18.90%.P<0.001)and the postoperative immediate meaningless residual stone rate(31.1% vs.18.93%.P = 0.043)than the NTrapURL group.Postoperative hospitalstay(2.34 ± 0.96 d vs.2.21 ± 0.88 d.P = 0.339)showed no significant difference between the two groups.The surgery cost of FURL group was higher than that of NTrapURL group[22836.00(21134.10,24653.13)vs.11703.00(10666.05,13649.25).P<0.001].stone-freerate after one month was higher in the FURL group than in the NTrapURL group(94.6% vs.81.07%.P = 0.006).There were not serious complications such as severe postoperative infection,ureteral perforation or avulsion occurred in both groups.The main complications were hematuria(31.08% vs.23.67%.P = 0.316)and pain(43.24% vs.50.30%.P = 0.174),fever(1.35% vs.3.55%.P = 0.438),that had not significant difference between the two groups.The long-term postoperative complications was mainly ureteral stenosis,and there were no significant difference between the FURL group and the NTrapURL group(0 vs.3.55%.P = 0.181).There were no significant difference for postoperative double J ureteral catheterindwelling time(4.11 ± 0.77 w vs.4.05 ± 0.44 w,P = 0.463)and the hydronephrosis improvement rate(91.90% vs.89.94%.P = 0.871)between the two groups.There was one case of recurrence of postoperative stones(1.35% vs.0.59%.P = 0.532)in both groups.Conclusion: FURL and NTrapURL are safe and effective in the treatment of upper ureteral calculi,but FURL has a higher stone-free in the treatment of upper ureteral calculi.