Comparison Of Three Minimally Invasive Surgical Treatments For Upper Ureteral Calculi

BACKGROUND:Ureteral calculus is one of the common diseases in the urologic disease, which mostly can be induced by renal calculus, though primary ureteral calculus is infrequent. In the past several decades, the treatment for ureteral calculus has changed from the previous surgical operation to the current therapic methods, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscope (URL), mini-percutaneous nephrolithotripsy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU), which can be chosen according to different patients.OBJECTIVE:The study summarized the methods for the treatment of upper ureteral calculi and assessed the efficacy and safety of the three kinds of techniques. Moreover, the operation skill and influencing factor of the three methods were investigated in the study.PATIENTS AND METHODS:In the study,198 patients with upper ureteral calculi were retrospectively reviewed, who were treated in the three methods in our hospital from January 2008 to January 2011, and the cure rate of the three methods were analyzed and compared. All of the patients were examined by B-mode ultrasonography, plain abdominal radiograph (KUB) and intravenous pyelography (IVP). Moreover, if the visualization of calculi was not clear, the computer tomography (CT) of kidney and ureter was performed. URL:under the lumbar anesthesia and epidural anesthesia, F8/9.8 ureteroscope was inserted into the ureter, and the calculi were shattered by Holmium Laser. Double-J stent and urethral catheter were placed after the operation. The urethral catheter was removed one day later and the Double-J stent was removed one month after the operation. MPCNL: under the lumbar anesthesia and epidural anesthesia, the ureter with calculi was intubated and the upper or middle calyces was piqured between the number 11 costa and the number 12 costa under the conduction of B-mode ultrasonography. F8/9.8 Ureteroscope was placed, and the calculi were shattered by Holmium Laser. Double-J stent, kidney fistula and urethral catheter were placed after the operation. The urethral catheter and kidney fistula were removed according to the condition. The double-J stent was removed one month after the operation. RLU:under the general anesthesia, the ureter was cut and the calculi were removed after the pneumoperitoneum was established. The ureter was sutured after the double-J stent was placed, and double-J stent was removed after the operation.RESULTS:106 patients were treated by the method of URL, and the diameter of calculi ranged from 0.8cm to 1.6cm with the average of 1.21cm. With the method of URL, the clearance was 80%(85/106) one month later. RLU was performed in 8 patients (7.5%) because of ureterostenoma or perforation, and the complication rate was 2.8%(3/106).51 patients were treated by the method of MPCNL, and the diameter of calculi ranged from 0.7cm to 1.7cm with the average of 1.23cm. With the method of MPCNL, the clearance was 100%(51/51) one month later, and the complication rate was 3.9%(2/51).41 patients were treated by the method of RLU, and the diameter of calculi ranged from 1.0cm to 2.3cm with the average of 1.53cm. With the method of RLU, the clearance was 100%(41/41) one month later, and the complication rate 2.4%(1/41). Compared to the URL, the MPCNL and RLU have higher clearance of calculi one month later after the operation, and significant differences were observed. There no significant difference between MPCNL and RLU in the clearance of calculi one month later after the operation. Moreover, no significant difference was observed in the complication rate among groups.CONCLUSIONS:All of the three methods were effective and safe operation for the treatment of ureteral calculus. Compared to the URL, the MPCNL and RLU have higher clearance of calculi, and the experience operator and the choice of patients had influence.