The Management Of Proximal Ureteral Caiculus:flextble Ureteroscopy Or Minimally Invasive Percutaneous Nephrolithotomy?

Objective:To investigate the efficacy and comparative advantagestudy between flexible Ureteroscopy and Minimally Invasive Percuta-neous in the Management of proximal ureteral calculus.Methods:Between May2013and October2014,a total of88patientswho were treated in China-Japan Union Hospital of Jilin University withone stone in the proximal ureter(10mm~20mm) were Randomly chose inthis research. There were42patients who were treated with flexible ure-teroscopy,as group of FURS.46of the patients were underwentmini-percutaneous nephrolithotomy, as group of mPNL. The cases of twogroups of age, gender, the degree of hydronephrosis, stone size, operationtime, surgical complications (based on clavein system), stone-free rate,postoperative hospital stay and hospital cost were underwent the statis-tical analysis by SPSS19.0.Results:Age(year):47.9±11.4and49.6±11.2（P=0.482）; Sex (male/female)：26/16and24/22（P=0.357）;Degree of Kidney seeper（slight/moderate）:20/22and18/28（P=0.422）；Stone size:14.8±2.7and14.6±2.6（P=0.720）;operative duration:76.52±11.28and41.41±7.11（P<0.001）;total complication rate:19%and26.1%（P=0.431）.In FURS group,therewas one case occured incomplete ureteral perforation,who removedurethral catheter1week after the surgery and indwelt double J tube for2months.No ureteral stricture、leakage or other complications occurredafter3months follow-up. The rest of the7cases were Clavien1compli-cations. In mPNL group, there was1case appeared late-onset bleedingafter removed the renal fistula.The patient did not take a turn for the bet- ter by giving blood transfusion, continued to the naked eye hematuria.Thecase gradually improved after renal selective arterial embolization.Thiswas a category Clavien3complications;3cases of mPNL group wereClavien2complications,8cases were Clavien1complications; stone-freerate after a single procedure(residual≤3mm):76.2%and91.3%（P=0.053）;stone-free rate afer3months:92.9%and100%（P=0.209）In FURS group,there are three patients underwent ESWL and drug rowstone therapy.The stone-free rate was100%in mPNL group;postoperativehospital stay:2.79±0.84and5.09±0.78（P<0.001); hospitalization costs:36069.1±1325.5and26439.5±827.9(P<0.001) in FURS and mPNLgroups respectively.Conclusions:1.Both FURS and mPNL are effective and safe surgical options forpatients with single stone in the proximal ureter.2.FURS is more minimally invasive, shorter hospitalization time andquick recovery. mPNL is dominate in operation time and operation cost.