RESUMO
Objective To compare ureteroscopic hthotomy (URL)and minimally invasive percuta-neous nephrolithotomy (MPCNL) for the management of upper-ureteral calculi ≥ 1.5 cm. Methods Fifty-eight patients with upper-ureteral calculi ≥ 1.5 cm were selected in randomized for URL group (35patients)or MPCNL group (23 patients). Ultrasonography and intravenous X-ray were performed for all pa-tients before surgery. Results In the URL group, 13 cases (37.1%)were rendered stone-free, 8 stones mi-grated upward to the pelvis of kidney. In these cases,a double- J stent was inserted, and ESWL was per-formed,7 cases had ureteral distortion, 3 cases had ureteral stricture, 4 cases had bad field of vision, MPCNL or open operation was performed in these eases. The mean operative time was 38 minutes (range 25-48 min-utes). In the MPCNL group,21 eases (91.3%)were rendered stone-free. In the other 2 patients,ESWL was performed because the stone fragments migrated upward to the pelvis of kidney. The mean operative time was 34 minutes (range 20-58 minutes). Conclusion Compared with URL,MPCNL is a safe and effective procedure for treating upper-ureteral calculi ≥ 1.5 cm.
RESUMO
Objective To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) forupper ureterie calculi or renal calculi without keeping nephrostomy drainage. Methods A total of240 patients with upper ureteric calculi or renal calculi undergoing PCNL were selected and randomizedto receive no nephrostomy drainage (Group A,120 patients) or a standard (14 F) nephrostomy drain age (Group B,120 patients) after lithotripsy was finished. Inclusion criteria included no urinary infec tion history,one stage operation,single percutaneona tract,no operative bleeding and no need for see ond percutaneous operation. The pain score,the number of patients requiring postoperative analgesiaand the incidence of urine leakage as well as postoperative hospital stay time of the 2 groups were not ed and compared. Results Compared with Group B,patients in Group A got lower pain scores at6 h,1 d and 2 d after the operation (4.2±1.5,2.1±1.6 and 1.2±1.0 vs 5.5±2.4,3.9±1.5 and2.5±1.5,respectively,P<0.01),with fewer patients requiring postoperative analgesia (15.0% vs26.7%,P<0.05),lower incidence of urine leakage (2.5% vs 23.3%,P<0.01) and shorter postop erative hospital stay (1.7±0.6 dvs 3.1±1.1d,P<0.01). Conclusion For selected patients,takeaway nephrostomy drainage right after PCNL could be considered as an effective method to get lesspostoperative pain,lighter economic burden and shorter recovery time.