Three minimally invasive approaches for treatment of ureteral calculi: a comparative analysis of 326 cases / 南方医科大学学报

ABSTRACT

<p><b>OBJECTIVE</b>To compare the therapeutic effect of 3 minimally invasive approaches for ureteral calculi removal and analyze their respective advantages and limitations.</p><p><b>METHODS</b>A retrospective analysis was conducted in 326 patients receiving extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URL) or percutaneous nephrolithotripsy (PCNL) for ureteral calculi. The clinical data including the stone-free rate and complications were analyzed.</p><p><b>RESULTS</b>The stone free rate was 78.5% (146/186), 91.2 (93/102) and 100% (38/38) in the 3 groups, respectively. According to the stone size, the ESWL group were divided into 3 groups with stone sizes of 0.5-1.0 cm, 1.0-2.0 cm and beyond 2.0 cm, and the stone-free rates were 90.8% (89/98), 69.3% (52/75), and 30.8% (5/13), respectively, showing significant difference between them (P<0.01). In URL group, surgical failure occurred in 9 cases, including 3 cases with difficult entry of the ureter, 5 with stone displacement to the kidneys, and 1 with residual stones over 4 mm. In PCNL group, the percutaneous renal access was successfully established and immediate phase I lithotripsy was performed in all the patients without severe complications recorded during nephrolithotripsy.</p><p><b>CONCLUSION</b>ESWL is the best option for cases with stone smaller than 10 mm. URL suits most of ureteral calculus cases, but successful entrance of the ureteroscope is a prerequisite and retrograde stone displacement is the primary reason for surgical failure. PCNL is effective in the management of complex upper ureteral stones, especially in cases of failed ESWL or ureteroscopy.</p>