Comparative study of ureteroscopic holmium laser lithotripsy, percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for the treatment of complex upper ureteral calculi

Abstract

Objective To compare the clinical effect and safety of ureteroscopic holmium laser lithotripsy (USL), percutaneous nephrolithotomy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU) for the treatment of complex upper ureteral calculi. Methods A total of 195 patients with complex upper ureteral calculi treated in our hospital from January 2014 to January 2017 were selected as research subjects. All of the patients were randomly divided into three groups with 65 patients in each group. Patients in the three groups were treated with USL, PCNL and RLU, respectively. The operation time, intra-operative blood loss, hospitalization time, operation success rate, postoperative complications and stone clearance rate of the three groups were compared. Results The operation time was significantly longer in RLU group than USL and PCNL groups (P 0.05). The hospitalization time was statistically longer in PCNL group than USL and RLU groups (P 0.05). The successful rate of the operations was 100.0%, 100.0% and 72.3%(47/65) in PCNL, RLU and USL groups, and the stone clearance was 95.4%(62/65), 100.0% and 83.0%(39/47), respectively. The successful rate and the stone clearance rate of PCNL and RLU groups were better than USL group (P 0.05). The incident of postoperative complications rate was 20.0%(13/65), 1.5%(1/65) and 10.6%(5/47) in PCNL, RLU and USL groups, with that of PCNL group the highest, while that of RLU group the lowest (P<0.05). Conclusions PCNL has advantages of short operation time, high stone clearance, but the intra-operative bleeding volume and postoperative complications are high. USL has less risk, but with low stone clearance. RLU is a safe and effective procedure with short operation time, less blood loss, fewer complications and high stone clearance rate. RLU is an ideal approach for the treatment of complex upper ureteral calculi. Key words: Ureteral Calculi; Holmium; Lasers, Solid-State; Nephrostomy, Percutaneous; Laparoscopy; Ureteroscopy