The effectiveness of percutaneous nephrolithotomy for the treatment of large impacted upper ureteral stones

Abstract

Objective: To compare the efficacy of semi-rigid or flexible ureteroscopic surgery and percutaneous nephrolithotomy, which is the standard method for the surgery of ≥2 cm upper ureteral impacted stones .
 Materials and Methods: The data of 123 patients who underwent stone surgery for ≥2 cm impacted ureteral stones in the upper ureter in our clinic were retrospectively analyzed. The patients were divided into two groups as ureteroscopic surgery group (URS, n = 59) and percutaneous nephrolithotomy group (PNL, n = 64) according to the type of operation. Patients with stones impacted in the ureter at the level between the L4 vertebra and ureteropelvic junction were included in the study. Preoperative demographic data and postoperative results of the patients in two groups were compared.
 Results: Average operation time was similar in both groups (p = 0.147). Mean hospital stay was significantly higher in the PNL group compared to the URS group (3.28 ± 0.57 days vs 1.11 ± 0.32 days, p = 0.001). Mucosal injury was developed in 10 (16.9%) patients in the URS group during the operation, while it was only 3 (4.7%) in the PNL group (p = 0.027). Postoperative urinary tract infection development was found to be similar in URS and PNL groups (8.5% vs 4.7%, p = 0.479). Postoperative stone-free rate was found to be significantly higher in the PNL group compared to the URS group (95.3% vs 79.7%, p = 0.008).
 Conclusion: PNL is a very effective and safe procedure in the surgical treatment of stones ≥2 cm in diameter impacted in the upper ureter. The complication rate of PNL is comparable with URS; however, it is seen that the PNL is more advantageous than URS in terms of postoperative total stone-free rate.