Clinical Study Of Minimally Invasive Percutaneous Nephrolithotomy And Retroperitoneal Laparoscopic Ureterolithotomy For Upper Ureteral Calculi

Objective:Clinical study of minimally invasive percutaneous nephrolithotomy (mPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU) for upper ureteral calculi was performed.Methods:From April2010to March2012,160cases which failed to be treated by conservative treatment and extracorporeal shock wave lithotripsy (ESWL) for upper ureteral calculi (stone diameter>1.5cm) were included. These cases were divided into two groups with80cases per group. The two groups underwent surgerical treatment by mPCNL and RLU, respectively. All these cases included light hydronephrosis group (42cases), modarate hydronephrosis group (64cases) and severe hydronephrosis group (54cases). Comparison between mPCNL and RLU for upper ureteral calculi in terms of postoperative one-time stone clearance rate, postoperative recovery time, amount of bleeding (comparing pre-operative hemoglobin and post-operative hemoglobin in blood routine of the first morning) and operative time was performed.Results:In group of the mPCNL, one-time stone clearance rate was95.24%,96.88%and100%in light, moderate and severe hydronephrosis group, respectively; postoperative recovery time was4.3±0.5days,4.8±0.3days and4.7±0.4days, respectively, with an average of4to6days; amount of bleeding was1.8±0.5g/dl,1.5±0.3g/dl and0.3±0.02g/dl, respectively; operative time was90±15minutes,85±20minutes and55±10minutes, respectively. In the group of the RLU, one-time stone clearance rate was all100%in light, moderate and severe hydronephrosis group; postoperative recovery time was4.5±0.6days,4.6±0.8days and4.6±0.5days, respectively, with an average of3to7days; amount of bleeding was0.2±0.06g/dl,0.2±0.04g/dl and0.2±0.03g/dl, respectively; operative time was60±15minutes,65±10minutes and75±10minutes, respectively. In the light and moderate hydronephrosis groups, there was no statistical difference in postoperative recovery time and statistical differences in the amount of bleeding and operative time were found. In the severe hydronephrosis group, there were no statistical differences in postoperative recovery time and amount of bleeding, but, statistical difference in operative time was observed. The one-time stone clearance rate was comparative between the two groups.Conclusion:(1) Both mPCNL and RLU are effective treatment measures for upper ureteral calculi (stones diameter>1.5cm) which was in failure by conservative treatment and ESWL(2) For those cases in light and moderate hydronephrosis, RLU is an ideal choice.(3) For those cases in severe hydronephrosis, mPCNL is considered to be the first choice.