Comparative analysis of upper ureteral stones (> 15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy.
OBJECTIVE
To investigate an appropriate treatment for patients with upper ureteral stones, > 15 mm in size, by comparing the therapeutic outcomes for those undergoing retroperitoneoscopic ureterolithotomy (RPUL) and rigid ureteroscopic pneumatic lithotripsy (URSPL) retrospectively.


METHODS
During the study period, 81 patients with a large upper ureteral stone (> 15 mm) were divided into two groups. RPUL was performed with retroperitoneal approach, and the stone was removed in group A. URSPL was conducted using a rigid ureteroscope, and pneumatic probe was used for lithotripsy in group B. The patient characteristics, success rate, stone-free rate, operation time, and complications were analyzed prospectively in the two groups.


RESULTS
The success rates of operation were 94.5% (34/36) in group A and 88.8% (40/45) in group B, but there were no significant differences between two groups (P > 0.05). After 4 weeks of follow-up, the stone-free rate after RPUL (100%, 34/34) and URSPL (77.5%, 31/40) groups were statistically different (P = 0.006). Furthermore, simultaneous ureterolithotomy and ureteroplasty by retroperitoneal laparoscopic surgery were performed on four patients combined with ureteral stricture. However, the mean operation time and hospital staying time after surgery in group A were longer than that in group B, and the differences were statistically significant (P < 0.05). The complication rate after RPUL (17.6%, 6/34) was lower than that after URSPL (20%, 8/40), but the differences were not statistically significant (P > 0.05).


CONCLUSIONS
RPUL is a safe and effective treatment technique for large, impacted, upper ureteral stones >15 mm in size when first-line treatments have failed or are unlikely to be effective. It can handle with combined pathologies simultaneously.
Wang
YunYan
Y
Department of Urology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, 215006, Suzhou, Jiangsu, China.
Hou
JianQuan
J
Wen
DuanGai
D
OuYang
Jun
J
Meng
JunSong
J
Zhuang
HaiJun
H
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy