Comparison Of Three Operative Methods For Treating Upper Ureteral Calculi

Objective:To investigate the therapeutic effect of Ureteroscopic Lithotripsy(URS),Percutaneous nephrolithotomy(PCNL)and Plexible ureteroscopic lithotripsy(FURS)in the treatment of upper ureteral calculi with diameter ≥ 1.0 cm.Methods: 466 patients with upper ureteral calculi in our hospital from September 2016 to September 2020 were selected as the research objects.They were divided into PCNL group,URS group and FURS group.The operation time,postoperative hospital stay,postoperative stone clearance rates,stone clearance rates after 1 month and complications were analyzed retrospectively.Results: There were 227 cases in URS group,143 cases in PCNL group and 96 cases in FURS group.There were 328 males(70.4%)and138 females(29.6%)with an average age of 52.81±13.73 years(range18-91years).The length and size of stones ranged from 1.0 cm to 6.0 cm,with an average of1.63±0.64 cm.There was significant difference among the three groups(P<0.05).There were 35 cases(7.5%)without hydronephrosis before operation,92 cases(19.7%)with mild hydronephrosis,150 cases(32.2%)with moderate hydronephrosis and 189 cases(40.6%)with severe hydronephrosis.There was no significant difference between the three groups in stone side and degree of hydronephrosis(P<0.05).The operation time was 71.4±35.11 min in URS group,109.12±41.46 min in PCNL group and 106.72±45.92 min in FURS group.There was significant difference among the three groups(P<0.05).There were significant differences between URS group and PCNL group,URS group and FURS group(P<0.05).There was no significant difference between FURS group and PCNL group(P>0.05);there was significant difference between URS group and PCNL group,FURS group and PCNL group(P<0.05).In terms of postoperative indicators,the average length of hospital stay was 3.86±1.21 days in URS group,6.16±2.07 days in PCNL group,and 3.53±1.32 days in FURS group.There were significant differences amongthe three groups(P<0.05).There were significant differences between URS group and PCNL group,FURS group and PCNL group(P<0.05).Postoperative pain score(VAS)ranged from 0 to 9,with an average of 2.7.There were significant differences between URS group and FURS group,FURS group and PCNL group(P<0.05).The stone clearance rates was72.7% in URS group,89.5% in PCNL group and 70.8% in FURS group at 3days after operation(P<0.05);the stone clearance rates was 79.7% in URS group,95.1% in PCNL group and 91.7% in FURS groupat 1 month after operation(P<0.05);the stone clearance rates at 1 month after operation was significantly different between URS group and FURS group,and between URS group and PCNL group(P>0.05).The PCNL group had 2 cases(1.40%)of blood transfusion,the others two types of blood transfusion did not occur.There were significant differences in theclassification of complications among the three groups(P<0.05),and therewere significant differences between URS group and PCNL group,FURS group and PCNL group(P<0.05).Conclusions: URS,PCNL and FURS are the surgical methods for the treatment of upper ureteral calculi.URS has a certain failure rate,but it has the advantages of less trauma,shorter postoperative hospital stay and fewer complications.PCNL has a higher stone clearance rates,but compared with the other two surgical methods,PCNL has larger trauma,longer hospital stay and more complications.FURS has the advantages of less trauma,shorter postoperative hospital stay and fewer complications.However,ureteral stents need to be placed before FURS,whichtakes longer operation time and higher cost.