Patient Preference For Three Different Surgical Methods On The Therapeutic Effect In Upper Ureteral Calculi

Objective According to patients preference for surgical risks and curative effects,three different surgical methods,including(percutaneous nephrolithotomy(PCNL)、ureteroscopic lithotripsy(URL)and retroperitoneal laparoscopic ureterolithotomy(RLU))were provided for patients to choose to treat upper ureteral calculi with a diameter of≥1.0cm.The treatment efficacy and safety were evaluated.Methods From June 2015 to December 2017,patients who suffered for upper ureteral calculi with a diameter of≥1.0cm and admitted to the hospital were collected retrospectively.Of which,PCNL,URL or RLU could be used for surgical intervention.After fully informed consent for understanding the surgical methods and their advantages and disadvantages,patients chosen the final surgical method.The operative time,immediate stone free rate and SFR afer one month,postoperative pain score,preoperative and postoperative changes of white blood cells and red blood cells,surgical complications,postoperative hospitalization days and total hospital expenses of three groups were analyzed.Results A total of 266 patients were included in the analysis,14.3%(38/266)of patients chose PCNL,62.4%(166/266)of patients chose URL and 23.3%of patients chose RLU.In the PCNL group(38 cases),the stone diameter were 2.09±0.58cm.23 patients had moderate to severe hydronephrosis;In the URS group(166 cases),the stone diameter were 1.30±0.31cm,13 cases presented with moderate to severe hydronephrosis;In the RLU group,the stone diameter were 1.64± 0.38cm,22 cases presented with moderate to severe hydronephrosis.The stone free rate showed no significant difference between the PCNL group(94.7%)and the RLU group(100%)(P=0.068)one month after surgery.However,significant differences were observed between the URL group(81.3%)and PCNL group(94.7%),URL(81.3%)and RLU(100%)(P=0.043,P=0.000,respectively);In terms of postoperative comfort,postoperative pain of patients in the PCNL group were 6.05±2.34 points,postoperative pain of patients in the RLU group were 3.24±1.32 points,and postoperative pain of patients in the URL group were 2.14±1.13 points,there were significant differences among the three groups(P<0.05).In terms of bleeding,the URL group was significantly less than the other two groups(P<0.05).In the terms of infection,the RLU group had no significant difference with URL group,and both of them were better than the PCNL group(P<0.05).In the terms of postoperative hospitalization days,the patients in URL group is the shortest;the average medical cost in the URL group was similar with that in RLU group,but both of them were lower than that in PCNL group.Conclusion Three methods(PCNL、URL and RLU)mentioned above are safe and effective methods for the treatment of upper ureteral calculi.Patient can select the most suitable treatment method according to their preference after fully informed consent.URL has the characteristics of less postoperative complications,lower postoperative pain scores,less postoperative hospitalization days and total hospital expenses,et al,and has become the most preferred surgical method for patients;PCNL is especially suitable for the stones with the larger diameter,medium-heavy water and ipsilateral lower renal calyces,however given the risk of hemorrhage and pain,PCNL is the least selection;As a second-line treatment scheme,RLU can be used as an alternative treatment for patients considering surgical tisks and complications,and it still plays an important role in URL failure,poor ureteral conditions,and other diseases requiring simultaneous treatment.