RESUMEN
Objective: To compare the safety and effectiveness of flexible ureteroscopy [F-URS] with transperitoneal laparoscopic ureterolithotomy [TPLU] in cases of obstructive pyelonephritis secondary to large proximal ureteral stones
Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU [Group I], and 20 patients were treated with F-URS [Group II]. Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group
Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone-free rate [100% vs 80%. p=0.043] and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain [p=0.008], a shorter hospital stay [p<0.001] and a faster return to daily activities [p<0.001]
Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities
RESUMEN
Objective: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension [HT], diabetes mellitus [DM] and body mass index [BMI]. Methods: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. Results: Of the 121 patients with kidney stones 30 [24.7%] had HT, while 66 [14.5%] of the 453 patients without stones had HT [p=0.007]. BMI values of those with and without stones were 27.2 +/- 4.93 kg/m2 and 25.29 +/- 4.12 kg/m2, respectively [p<0.001]. Twenty-five [20.6%] of the patients with stones diagnosed by ultrasound had DM, while 49 [10.8%] of those without stones had DM [p=0.004]. When comparing patients with and without kidney stones, logistic regression analysis revealed that DM [odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013] and BMI [OR 1.08, CI 1.03 to 1.13, p=0.003] were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter [CSD] and stone surface area [SA] evaluated for stone burden. Conclusions: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden