Comparison Of The Clinical Efficacy Of Flexible Ureteroscope Combined With Ureteroscope And Retroperitoneal Laparoscopic Ureterolithotomy In The Treatment Of Upper Ureteral Calculi

Objective:To compare the efficacy and safety of flexible ureteroscope combined with ureteroscope and retroperitoneal laparoscopic ureterolithotomy(RLU)in the treatment of upper ureteral calculi(UUC).Methods:A total of 192 patients with UUC who were treated in our hospital between October 2018 and October 2020 were retrospectively studied.It is classified into two groups based on the different operation methods: flexible ureteroscope combined with ureteroscope group(n=87)and retroperitoneal laparoscopic ureterolithotomy group(n=102).Compare the operation-related clinical clinical indicators in the two groups,such as stone free rate(SFR),postoperative ESWL rate,surgery duration,approximate intraoperative bleeding,hospitalization time,incidence of complications and so on,to analyse the discrepancies in the efficacy of the two procedures for the treatment of UUC.Results:1.The results of the comparisons of preoperative general data such as age,gender,stone side,stone size and whether it was combined with renal insufficiency between the two groups showed no significant discrepancies(all P>0.05).2.Comparison of the efficacy of the two groups of patients: the stone free rateo f the retroperitoneal laparoscopic ureterolithotomy group in one-time treatment(99.05% vs87.36%.P<0.001)and one month post-operative(100% vs 93.01%.P=0.020)obviously superior to the flexible ureteroscope combined with ureteroscope group,the discrepancies were statistically significant;the post-operative ESWL rate(0.95% vs 9.20%.P=0.019)in the retroperitoneal laparoscopic ureterolithotomy group was obviously less than that of the flexible ureteroscope combined with ureteroscope group,the discrepancy was statistically significant.3.Comparison of surgery-related clinical indicators between the two groups: the surgery duration(57.89 ± 8.96 min vs 79.41 ± 10.56 min.P<0.001)and the length of hospital stay(7.08 ± 2.39 vs 8.22 ± 2.78.P=0.003)in the flexible ureteroscope combined with ureteroscope group,approximate intraoperative bleeding(10.33 ± 3.35 ml vs 30.80 ±9.37 ml.P<0.001)and postoperative exhaust time(20.43 ± 4.99 h vs 25.40 ± 5.96.P<0.001)were significantly better than the retroperitoneal laparoscopic ureterolithotomy group,the discrepancies were statistically significant;treatment cost: the treatment cost of the flexible ureteroscope combined with ureteroscope group(3.3408 ± 0.7788 vs 2.8379 ± 0.5100.P<0.001)was significantly higher than that of the retroperitoneal laparoscopic ureterolithotomy group,and the discrepancy was statistically significant.4.Comparison of complications in the two groups: 8 cases(9.20%)in the flexible ureteroscope combined with ureteroscope group had fever,2 cases(2.30%)in the postoperative ureteral stenosis,and 11 cases in the retroperitoneal laparoscopic ureterolithotomy group(10.48%),3 cases of urinary leakage(2.86%),and 6 cases of postoperative ureteral stenosis(5.71%).There were no significant discrepancy comparison of the incidence of complications such as fever,blood transfusion,urinary leakage,septic shock and postoperative ureteral stenosis between the two groups(all P>0.05).Although the total postoperative complications of 20 cases(19.05%)in the retroperitoneal laparoscopic ureterolithotomy group was higher than that in the flexible ureteroscope combined with ureteroscope group in 10 cases(11.49%),the discrepancy was not statistically significant(P>0.05).Conclusion:1.Both the flexible ureteroscope combined with ureteroscope and the retroperitoneal laparoscopic ureterolithotomy can safely and effectively treat the upper ureteral calculi.However,for larger,hard-textured upper ureteral calculi,the retroperitoneal laparoscopic ureterolithotomy may have a higher postoperative stone free rate and lower postoperative ESWL rate.2.The flexible ureteroscope combined with ureteroscope treatment of UUC has the characteristics of relatively shorter surgery duration,less hospital days,less approximate intraoperative bleeding and lower overall postoperative complication rate,which is easily accepted by patients,but the treatment cost is higher.3.The flexible ureteroscope combined with ureteroscope treatment of UUC has obvious effect and high safety,more micro-invasive,fast recovery,and has positive significance for the rehabilitation of patients,so it is worth recommending for the majority of clinicians.