Comparison Of URL Effect With PCNL Effect Intreatment And Health Economics Of Proximal Ureteral Calculi

Objective:To provide theoretical guidance on how to choose the best surgical way with the less financial input to the patients with upper ureteral calculi by evaluate the clinical efficacy and cost of the percutaneous nephrolithotomy (PCNL)and ureteroscopic lithotomy (URL) in the patients receiving treatment of upper ureteral calculi last year.Methods:A number of120cases suffered with upper urinary tract calculi were collected form Sept.2011to2012Sept. they all underwent KUB+IVU, B ultrasound and CT examination before surgery.60cases of them received PCNL, and others received URL. The number of men and women is the same,18--70years old without serious complications and operation contraindication. Then, to evaluate the operation success rate, the length of operation time, operation cost (expense of western medicine and antibiotics), the average hospitalization time according to dfferent stone size, location.Results:In a number of120cases,63cases were diagnosed with left ureteral stones, and57cases with right ureteral stones,61cases with Moderate hydronephrosis,59cases with Severe hydronephrosis. Preoperative clinical data of two groups of patients were analyzed by student t test,and the difference was not statistically significant(P＞0.05). In60patients performed by URL,the operation was successful in44cases,with a surgical success rate73.3%,opertion time19.4±9.7min,hospitalization time5.7±3.3days,charges of western medicine2337.5±1202.6yuan. In60patients performed by PCNL,the operation was successful in57cases,with a surgical success rate95.0%,opertion time15.6±6.0min,hospitalization time7.1±1.9days,charges of western medicine4301.8±612.5yuan.All indicators between two groups were analyed by student t test and we found that URL group’s surgical success rate,hospitalization time,charge of western medicine were less than PCNL group.while the PCNL group of the success rate of surgery and the rate of stone clearance were higher than the URL group. In60patients performed by URL,which consisted21cases of stones above the upper edge of the second lumbar vertebrae,21cases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae,18cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest.Stones of16patients in URL group had returned to the renal collecting system during operation, which consisted7cases of stones above the upper edge of the second lumbar vertebrae,7cases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae,2cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest. Success rate of URL group among different locations had significant difference by using chi-square test.In60patients performed by PCNL,which consisted20cases of stones above the upper edge of the second lumbar vertebrae,19cases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae,21cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest.Stones of16patients in PCNL group didn’t clear up the stone during operation, which consisted1cases of stones above the upper edge of the second lumbar vertebrae,Ocases of stones between the level of lower edge of the second lumbar vertebrae and the lower edge of the third lumbar vertebrae,2cases of stones between the level of the third lumbar vertebrae and the upper edge of iliac crest. Success rate of PCNL group among different locations had significant difference by using chi-square test. In60patients performed by URL,which consisted of18cases of stone is larger than2cm in diameter,22cases of stone’s diameter between1cm to2cm,20cases of stone is smaller than1cm. Stones of16patients in URL group didn’t clear up the stone during operation, which consisted of7cases of stone is larger than2cm in diameter,7cases of stone’s diameter between1cm to2cm,2cases of stone is smaller than1cm. Success rate of URL group among different stone size had significant difference by using chi-square test. In60patients performed by PCNL,which consisted of23cases of stone is larger than2cm in diameter,20cases of stone’s diameter between1cm to2cm,17cases of stone is smaller than1cm. Stones of3patients in PCNL group didn’t clear up the stone during operation, which consisted of1eases of stone is larger than2cm in diameter,1eases of stone’s diameter between1cm to2cm,1cases of stone is smaller than1cm. Success rate of PCNL group among different stone size had significant difference by using chi-square test.Conclusions:1For the ureteral calculi in the upper, the cost of medicine in PCNL is far more expensive than URL,so does the time for treatment. But in general, the success rate of PCNL is much more high than URL,besides,the operation time is shorter.2For URL, Its main advantages are simplify operating progress and less damage which lead to less cost of medicine and shorter treatment time compare to (?) PCNL.But considering the success rate(as secondary surgery operation will lead to mucu more cost and damage),we suggest that PCNL is probably the better choice for the ureteral calculi in the upper.3The sample of this experiment after statistics analysing shows that in some cases, the success rate and operating time of PCNL and URL are almost equal for the ureteral calculi in the upper(the stone below L3lower edge or less than1cm) as the development of treating equipment, especially the development of experience in urologists.However,URL leads to less damage.That is to say,for certain ureteral calculi in the upper(the stone is lower than L3lowe edge and smaller than1cm),it is reasonable to choose URL for a effective treatment.For most parts,PCNL seems more recognized and reasonable.