A Clinical Comparative Study On The Treatment Of 1-2cm Upper Urinary Tract Calculi By Shuo Tong Ureteroscopy Combined With Flexible Ureteroscopy And Minimally Invasive Percutaneous Nephrolithotomy

Objective:To investigate the clinical value of Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy by compare the clinical efficacy of Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy and Minimally Invasive Percutaneous Nephrolithotomy in the treatment upper urinary tract calculi（long diameter 1-2cm）.Methods:Retrospective analysis was used in this study.According to the inclusion and exclusion criteria,87 patients with upper urinary tract stones treated in our hospital from September 2020 to December 2021 were selected as the research objects.The stones were all located in the unilateral upper ureter,renal pelvis or calyx.Among them,41 cases underwent Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy（ST-URL group）,and 46 cases underwent Minimally Invasive Percutaneous Nephrolithotomy（MPCNL group）.The stone clearance rate（Stone clearance rate,SFR）,the reoperation rate rate,the operation time,the decrease of Hemoglobin（Hb）on the first day after operation,the complications,the changes of inflammatory factors and renal function indexes on the first day after operation,the visual analog pain score（VAS）on the first day after operation,the postoperative hospital stay and total hospitalization expenses were compared between the two groups.Results:There was no significant difference in the general data between the two groups（P>0.05）.There was no significant difference in overall SFR between the two groups（ST-URL 90.2%vs.MPCNL 95.7%,P>0.05）,but the reoperation rate rate was higher in ST-URL group（17.1%vs.2.2%,P<0.05）.There was no significant difference in operation time between the two groups[ST-URL（42.93±6.77）vs.MPCNL（41.09±6.12）min,P>0.05].Patients in MPCNL group lost more blood after operation[the decrease of Hb on the first day after operation:（2.49±1.63）vs.（7.96±3.65）g/L,P<0.01].There was no significant difference in preoperative white blood cell count（WBC）,C-reactive protein（CRP）and serum creatinine（Scr）between the two groups;WBC and CRP in the two groups were higher than those before operation（P<0.05）.There was no significant difference in WBC between the two groups[ST-URL（6.76±1.41）vs.MPCNL（7.11±1.61）′10~9/L,P>0.05],but the level of CRP in MPCNL group was higher[（5.83±1.88）vs.（8.69±4.49）mg/L,P<0.01];There was no significant increase in postoperative Scr in the two groups（P>0.05）,and there was no significant difference in postoperative Scr between the two groups（P>0.05）.In terms of complications,there was no significant difference in fever rate,blood transfusion rate,perirenal hematoma rate and ureteral injury rate between the two groups（P>0.05）.There were no serious adverse events such as ureteral perforation or avulsion,perirenal organ injury and urogenic sepsis in the two groups.The VAS was lower in ST-URL group on the first day after operation[（1.54±0.81）vs.（3.54±1.03）,P<0.01].The postoperative hospital stay was shorter in ST-URL group[（3.61±0.95）vs.（8.39±0.95）days,P<0.01].The total hospitalization cost of ST-URL group was lower[（16778.29±1260.23）vs.（23187.64±1136.89）yuan,P<0.01].Conclusion:（1）Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy and Minimally Invasive Percutaneous Nephrolithotomy are both safe and effective methods for the treatment of 1-2cm upper urinary tract calculi.They have their own advantages and disadvantages;（2）Advantages of Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy:less blood loss,less postoperative inflammatory reaction,less postoperative pain,shorter postoperative hospital stay and less economic burden;（3）Disadvantages of Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy:the secondary operation rate is higher;（4）Shuo Tong Ureteroscopy combined with Flexible Ureteroscopy is safe and effective in the treatment of 1-2cm upper urinary tract calculi,which is worthy of clinical application and promotion.