ABSTRACT
OBJECTIVE: To compare the clinical effects of three minimally invasive surgeries on the treatment of impacted upper ureteral calculi. METHODS: 135 patients with impacted upper ureteral calculi were selected and randomly divided into three groups (Group A-C) (n=45), which were treated with transurethral ureteroscopic lithotripsy, minimally invasive percutaneous nephrolithotomy, and retroperitoneal laparoscopic ureterolithotomy respectively. Relevant results of the three groups were compared. RESULTS: The surgery time of Group C was significantly longer than those of Group A and Group B (P < 0.05). The postoperative hospitalization time of Group B was significantly longer than those of Group A and Group C (P < 0.05). 37.78% (17/45) of Group A patients required extracorporeal shock wave lithotripsy, being significantly more than those in Group B (6.67%, 3/45) and Group C (0, 0/45) (P < 0.05). The postoperative calculus clearance rate of Group A (51.11%, 82.22%) was significantly lower than those of Group B (91.11%, 97.78%) and Group C (93.33%, 100%) (P < 0.05). The incidence rates of postoperative complications in Group A-C were 11.11% (5/45), 8.89% (4/45) and 6.67% (3/45) respectively without significant differences (P > 0.05). CONCLUSION: The three surgical methods for impacted upper ureteral calculi should be selected according to practical conditions to improve therapeutic effects and to ensure safe surgery.
ABSTRACT
Objective To explore the safety and efficiency of holmium laser percutaneous nephrolithotomy in the treatment of upper ureteral calcui.Methods A retrospective analysis was made on 132 cases of upper ureteral calcui treated by holmium laser percutaneous nephrolithotomy.After retrograde placement of the ureteral catheter,a track from the skin surface into the middle renal calyx was established under the guidance of a C-arm fluoroscopy.Then a ureteroscope was passed to introduce a holmium laser lithotriptor.Stones were broken up and a nephrostomy tube was placed in the incision to carry fluid from the kidney.Results Holmium laser percutaneous nephrolithotomy was completed on one session in all the 132 cases(155 sides),including 116 cases of single-tract nephrolithotomy and 16 cases of double-tract nephrolithotomy.The stone-free rate was 95.5%(148/155).The duration of operation was 30~320 min(mean,108 min).The intraoperative blood loss was 50~200 ml(mean,100 ml).No blood transfusion was required and no postoperative hemorrhage happened.No analgesics were needed after operation.The nephrostomy tube was left for 3~8 d(4.6 d).The length of postoperative hospital stay was 5~11 d(mean,7.4 d).Follow-up observations in the 132 cases for 1~6 months(mean,3 months) showed complete relief of symptoms.B-ultrasonography showed a mean of renal pelvis separation of 15 mm,which had decreased by 9~28 mm postoperatively.Conclusions Holmium laser percutaneous nephrolithotomy is safe and effective in the treatment of upper ureteral calcui.
ABSTRACT
Objective To evaluate the feasibility of retroperitoneal laparoscopy for patients with upper ureteral calculi. Methods A total of 35 patients with upper ureteral calculi were treated with retroperitoneal laparoscopy. Results The operation was completed in all but one patient, who was converted to open surgery because the calculi moved into the renal pelvis. The operation time ranged from 70 to 135 minutes (mean, 110 minutes). Intraoperative blood loss was 20 to 55 ml (mean, 36 ml). No patient had over-2-day urine leakage. Retroperitoneal drainage tube was removed 2 to 3 days after the operation. The postoperative hospital stay ranged from 6 to 10 days (mean, 7.8 days). One month after the operation, when double-J catheter was removed, ultrasonography showed that 9 cases who had severe hydronephrosis before operation was relieved. In the 26 patients with mild or moderate hydronephrosis, the symptoms disappeared in 17, and were relieved in the other 9. Seven patients with severe hydronephrosis and 11 patients with mild or moderate hydronephrosis achieved a 2-to 6-month follow-up, none of them developed recurrent calculi during the period. The severity of hydronephrosis in these patients was same to that determined one month postoperation. Conclusions Retroperitoneal laparoscopy is feasible for patients with upper ureteral calculi. The method can be used as an alternative to open surgery of microinvasive operation.
