Comparison of tubeless-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy in the treatment of incarcerated upper-ureteral calculi sized ≥1 cm
Abstract：Objective: To compare the efficacy and safety of tubeless mini-invasive percutaneous nephrolithotomy (mPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU) for the treatment of incarcerated upper-ureteral stones (≥ 1 cm in size). Methods: Fifty-six patients with incarcerated upper-ureteral calculi (≥ 1 cm in size), which were divided into mPCNL group (33 cases) and RLU group (23 cases) respectively, were included in the retrospective investigation. The operative time, the intraoperative blood loss (hemoglobin reduction), the operation success rate, the stone clearance rate, the postoperative hospital stay and the incidence of complications were compared. Results: There were significant differences in operative time, hospitalization days and hemoglobin decrease between the two groups (P < 0.05), but there were no significant differences in operation success rate, stone clearance rate and fever after operation (P > 0.05). In mPCNL group, one patient had retained a nephrostomy tube because of obvious bleeding from the percutaneous way. Active postoperative bleeding happened in two cases, which was recovered after medication treatment. In RLU group, the stone of one case moved up into the kidney cavity during operation and the procedure was converted to open surgery. Conclusions: Both mPCNL and RLU have satisfactory success rate and stone clearance rate for the treatment of large incarcerated upper-ureteral calculi. However, the operative time in mPCNL group is shorter, the trauma is milder, and the postoperative hospital stay is shorter too. Therefore, we think that the patients with incarcerated upper ureteral calculi are more suitable for the treatment of tubeless MPCNL.
