Comparison Over-table Position ESWL, Prone Position ESWL And URL In Treatment Of Lower Ureteral Calculi

Objective By comparing the efficiency, safety and charge of Over-table positionextracorporeal shock wave lithotripsy (ESWL),Prone position extracorporeal shock wavelithotripsy and ureteroscopic holmium laser lithotripsy (URL) for ureteral calculi, todetermine which modality is more cost-effective.Method From Apr,2012to Aug,2013,a prospective study was conducted to comparethree modalities for the management of180patients with lower ureteral calculi which were6-15mm in diameter.Stone formers were random enrolled into three groups by randomnumber table:the OT position ESWL group,Prone position ESWL group and the URLgroup,every group has60cases.The stone fragments were collected for composition analysisby Fourier transform infrared spectroscopy(FTIR),and counting patients generalcondition,stones coposition,stone row rate,stone free rate,complication rate,efficiencyquotient(EQ),the hospitalization time and cost,to compare the efficiency, safety and charge ofthree modalities.Result No statistically significant difference was found in the patients’ demographicsand calculis’size,composition for three groups (P>0.05).The stone row rate and stone free rateof postoperative3days of the OT ESWL group,the Prone ESWL group and the URL group(76.7%、68.3%、91.3%and46.7%、41.7%、81.7%) were statistically significan（tP＜0.05）;thestone row rate of postoperative2weeks and1month of the OT ESWL group,the Prone ESWLgroup,the URL group (88.3%、81.7%、95%and93.3%、88.3%、96.7%) were no statistically significant（P＞0.05）,but the stone free rate of postoperative2weeks and1month of the OTESWL group,the Prone ESWL group and the URL group (76.7%、53.3%、83.3%and86.7%、71.7%、93.3%) were statistically significant（P＜0.05）.The complication rate of the ProneESWL group was higher than theOT ESWL group and URL group,but the differences were nostatistically significant（P＞0.05）;the efficiency quotient of the OT ESWL group was higherthan the Prone ESWL group and URL group,the differences were statistically significant（P＜0.05）;the operation time of the Prone ESWL group was higher than the OT ESWL group andURL group,the differences were statistically significant（P＜0.05）;the hospitalization timeand cost of the URL group were higher than the OT ESWL group and Prone ESWL group,thedifferences were statistically significant（P＜0.05）.The impact times and fluoroscopy time ofProne ESWL group were higher than the OT ESWL group,the differences were statisticallysignificant（P＜0.05）.Conclusion URL was effective option for lower stones with early postoperative higherstone row rate and stone free rate but more charge. OT ESWL as an emerging therapy wassuperior than the prone position, the forward stone row rate and stone free rate were close toURL, was cost-effective surgical method.