Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

Abstract

ObjectivesThe present study compared the safety and efficacy of combined laparoscopic ureterolithotomy (LU) and flexible ureteroscopy with percutaneous nephrolithotomy (PCNL) for removing large impacted upper ureteral stones with concurrent renal stones. MethodsThis study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones (group A) or PCNL (group B) for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016. Patient demographics, stone characteristics, and procedure-related parameters including stone-free rate, operation time, hospital stay after surgery, mean decrease in hemoglobin levels, visual analog scale (VAS) score, auxiliary procedure rate, and complication rate were compared between groups A and B. ResultsResults of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones. The stone-free rate after a single procedure was 95.7% in group A and 89.7% in group B (p = 0.62). The operation time was longer in group A than in group B (112.2 ± 23.3 min versus 96.2 ± 16.4 min, p = 0.006). However, no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery (5 days versus 6 days, p = 0.06). The decrease in hemoglobin levels was significantly higher in group B than in group A (−0.64 ± 0.36 g/dL versus −1.44 ± 0.65 g/dL, p < 0.0001). The mean VAS scores obtained at 24 hours (2.91 ± 1.08 versus 5.10 ± 1.01, p < 0.0001) and 48 hours after the surgery (1.09 ± 0.73 versus 2.28 ± 0.96, p < 0.0001) were significantly higher for group B than for group A. Moreover, the auxiliary procedure rate was higher in group B than in group A (6.9% versus 0%). ConclusionThese results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards. Despite the longer operation time, the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications. However, the choice of treatment depends on the preferences of surgeons and patients.