Safety and efficacy of retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi / 中华泌尿外科杂志

ABSTRACT

Objective:To compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of incarcerated upper ureteral calculi.Methods:The clinical data of 202 patients with incarcerated upper ureteral calculi treated in our hospital from January 2018 to April 2020 were analyzed retrospectively, including RIRS group treated with RIRS and PCNL group treated with PCNL.There was no significant difference in age [(54.40±11.17) years vs. (52.82±12.58) years], sex [male / female 86/54 vs. 45/17], body mass index [24.0(21.0, 27.0)kg/m 2 vs. 23.5(20.8, 26.3)kg/m 2], creatinine [75.45 (61.6, 93.3) μmol/L vs. 73.70 (62.4, 93.0) μmol/L], stone stay time [1.0 (0.5, 3.8) months vs. 1.0 (0.5, 6.0) months], stone hardness [(783.60 ±243.55) HU vs. (960.66 ±225.01) HU], stone diameter [(8.65 ±2.95) mm vs. (960.66 ±225.01) mm], stone location (65/75 vs. 34/28), proportion of infection before operation (40/140 vs. 25/62) and history of ESWL treatment (35/140 vs. 13/62) between the two groups. The operation time, hospital stay, perioperative complication rate, hospitalization cost and stone clearance rate were compared between the two groups. The high risk factors of preoperative stone characteristics (stone diameter, stone hardness, previous lithotripsy history, stone incarceration time, degree of hydronephrosis, infection) were scored (yes = 1, no = 0). Cases of complex stones were defined as ≥ 3 points. Simple stone cases were defined as < 3 points. Group analysis was carried out according to the score of stones in order to determine the influence of the choice of surgical methods on the results of operation. Results:All 202 operations were successfully done, and there was no transfer to open surgery or other surgical methods. Compared with the RIRS group, the operation time of the PCNL group was significantly shorter [48.5 (32.0, 62.5) min vs. 63.0 (48.0, 86.0) min, P<0.05], and the stone removal rate was significantly increased [98.4% (61/62) vs. 72.10% (101/ 140), P<0.05], the treatment cost was lower [1.16 (0.80, 1.40) ten thousand yuan vs. 2.73 (2.14, 3.32) ten thousand yuan, P<0.05]. The length of hospital stay in the RIRS group was shorter than that in the PCNL group [3.0 (2.0, 4.0) days vs. 8.0 (6.0, 9.0) days, P<0.05)]. There was no statistical difference in postoperative complications between the two groups [10.7% (15/140)) vs. 12.9% (8/62), P>0.05]. A comparative analysis of high-risk factors affecting stone removal revealed that for simple stone cases, the operation time was lower in the PCNL group than that in RIRS group [50.0(30.0, 64.0)min vs. 62.0(44.5, 86.0)min, P<0.05], the cost was lower [1.18 (0.80, 1.35) ten thousand yuan vs. 2.69 (2.22, 3.32) ten thousand yuan, P<0.05], and the stone removal rate was higher [100% (35/35)vs.78.3% (94/120), P <0.05], but the hospital stay was longer [ 7.0(6.0, 9.0) days vs.3.0(2.0, 4.0) days, P<0.05]. For complex stone cases, the operation time [46.0 (39.0, 61.0) min vs. 65.5 (51.0, 89.8) min, P<0.05] and hospitalization expenses [1.21 (0.98, 1.43) ten thousand yuan vs. 2.73 (2.13, 2.73) ten thousand yuan, P<0.05] in PCNL group were still lower than that in RIRS group, and the stone removal rate [96.3% (26/27)vs. 35% (7/20) , P<0.05] was also significantly higher than the latter. Conclusions:For simple stone cases, PCNL has a higher stone clearance rate, shorter operation time, lower treatment cost, and longer hospital stay than RIRS. For complex stone cases, the PCNL group has a higher stone clearance rate, shorter operation time, lower cost than RIRS group, but the length of hospital stay is no longer statistically different. Therefore, PCNL is more advantageous for the treatment of complex incarcerated upper ureteral calculi.