Abstract
Objective To explore the minimally invasive means for the treatment of ureteral calculi of the fourth lumbar vertebrae. Methods The clinical data of 358 cases were analyzed retrospectively. One hundred and eighty-seven cases were treated by minimally invasive percutaneous nephrolithotomy (MPCNL), 86 cases were treated by transurethral ureteroscopic pneumatic or holmium laser lithotripsy(URL), 23 cases by combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy, 62 cases were treated by retrograde intra-renal surgery (RIRS). The efficacy and complications were compared. Results The stone-free rate of one time was 96.3%, 90.7%, 100% and 100%, respectively. Residual stones were removed by adjuvant therapy. Fastest recovery and shortest hospital stay was observed in RIRS group. No severe complication were noted during 1 to 28 months follow-up. Conclusion MPCNL, URL, combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy, and RIRS are common treatments for ureteral calculi of the fourth lumbar vertebrae. Combination of percutaneous nephrostomy and transurethral ureteroscopy can be applied for some refractory cases. With the development of RIRS, RIRS is the first choice of ureteral calculi of the fourth lumbar vertebrae with mild to moderate hydronephrosis. Key words: Percutaneous nephrolithotomy; Ureteroscopy; Flexible ureteroscope; Ureteral calculi
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