title: Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections.
abstract: The aim of this study is to compare the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopic holmium laser lithotripsy (UHLL) as two minimally invasive procedures in managing obstructive upper ureteral calculi with concurrent urinary tract infections (UTI). The retrospective study included 189 patients who underwent unilateral obstructive upper ureteral stones with concurrent UTI from January 2007 to November 2014 at our institution. Patients received RPLU (81 cases) or UHLL (108 cases). All patients received preoperative anti-infection treatment (indwelling ureteral stent and/or preoperative antibiotics). Collected data, including sex, age, stone size, success rate, operation duration, post-operation hospitalization time, and post-operation complications, were compared. All patients were followed up for more than 6 months after surgeries, and no ureterostenosis occurred. The study included 189 patients, 41 (21.7 %) females and 148 (78.3 %) males with a medium age of 52 years (range 22-81 years). All surgeries were successfully performed without conversion to open surgery. Stone size in the RPLU group was larger than that of the UHLL group (16.1 ± 1.4 vs. 10.4 ± 1.6 mm, P = 0.012). Operative duration (P = 0.009) and hospitalization time (P < 0.001) in the UHLL group were significantly shorter than those in the RPLU group, whereas stone clearance rate was significantly higher in the RPLU group (100 vs. 88.9 %, P = 0.002). Of note, postoperative fever was more common in patients treated with UHLL (15 cases) versus RPLU (4 cases) (13.9 vs. 4.9 %, P = 0.043). Moreover, in the UHLL group, three patients without a preoperative indwelling ureteral stent were complicated with sepsis, which was not seen in RPLU group. In our study, the safety and stone clearance rate of RPLU are better than those of UHLL in the treatment of unilateral upper ureteric calculi with concurrent UTI. Preoperative antibiotics and indwelling ureteral stent may reduce the risk of postoperative infections.
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Jun-Tao
authors.initials: JT
authors.lastname: Jiang
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Li
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Zhu
authors.affiliation: Department of Geriatrics, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Wen-Lan
authors.initials: WL
authors.lastname: Sun
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhong
authors.affiliation: Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Wood
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Wei
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China.
authors.forename: Shu-Jie
authors.initials: SJ
authors.lastname: Xia
authors.affiliation: Department of Urology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China. sunxiaow1973@163.com.
authors.forename: Xiao-Wen
authors.initials: XW
authors.lastname: Sun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D006695:Holmium; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012737:Sex Factors; D015607:Stents; D014513:Ureter; D014514:Ureteral Calculi / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D014552:Urinary Tract Infections / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents; D006695:Holmium
keywords: Hydronephrosis; Laparoscopic ureterolithotomy; Obstructive pyelonephritis; Upper ureteral stone; Ureteroscopic holmium laser lithotripsy