Clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy for large impacted proximal ureteral calculi: a prospective, randomized study.
OBJECTIVE
To evaluate the clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy (POBC-URSL) for large impacted proximal ureteral calculi.


METHODS
156 patients with impacted proximal ureteral stones ≥1.5 cm in size were randomized to ureteroscopic lithotripsy (URSL), POBC-URSL, and percutaneous nephrolithotomy (PNL) group between May 2010 and May 2013. For URSL, the calculi were disintegrated with the assistance of anti-retropulsion devices. POBC-URSL was performed with the assistance of an 8F percutaneous occlusive balloon catheter. PNL was finished with the combination of an ultrasonic and a pneumatic lithotripter. A flexible ureteroscope and a 200 μm laser fiber were used to achieve stone-free status to a large extent for each group. Variables studied were mean operative time, auxiliary procedure, postoperative hospital stay, operation-related complications, stone clearance rate, and treatment costs.


RESULTS
The mean lithotripsy time for POBC-URSL was shorter than URSL, but longer than PNL (42.6±8.9 minutes vs 66.7±15.3 minutes vs 28.1±6.3 minutes, p=0.014). The auxiliary procedure rate and postoperative fever rate for POBC-URSL were significantly lower than URSL and comparable to PNL (p<0.01, p=0.034). POBC-URSL was superior to URSL with regard to the stone clearance rate at 3 days postoperatively, and as good as PNL (98.1% vs 75.0% vs 96.2%, p<0.01). The postoperative hospital stay and hematuria rate were lower in POBC-URSL group than PNL group and similar to URSL group (p=0.016, p<0.01). The treatment costs were lowest in POBC-URSL group ($1205.0±$113.9 vs $1731.7±$208.1 vs $2446.4±$166.4, p=0.004).


CONCLUSIONS
For large impacted proximal ureteral calculi, POBC-URSL was associated with a higher stone clearance rate, fewer complications and costs. POBC-URSL combined the advantages of URSL and PNL.
1 Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University , Tianjin, China .
Shiyong
S
Qi
Yanni
Y
Li
Xu
X
Liu
Changwen
C
Zhang
Hongtuan
H
Zhang
Zhihong
Z
Zhang
Yong
Y
Xu
D000328:Adult; D000704:Analysis of Variance; D021721:Balloon Occlusion / Q000379:methods; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008096:Lithotripsy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014514:Ureteral Calculi / Q000473:pathology / Q000601:surgery* / Q000648:ultrastructure; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D062885:Urinary Catheters