Effects of Stone Removal via Different Approaches in the Treatment of Incarcerated Upper Ureteral Calculi: A Comparative Study

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Abstract

Objective

The aim of this study is to investigate the clinical effects of percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy in the treatment of incarcerated upper ureteral calculi.

Methods

This study retrospectively reviewed 400 patients with incarcerated upper ureteral calculi admitted to the hospital from January 2016 to December 2021. Among them, 200 patients treated with percutaneous nephrolithotomy were included in the percutaneous group and 200 patients treated with transurethral ureteroscopic lithotripsy were included in the transurethral group. Perioperative indicators and stone clearance rates on day 7 and 1 month after operation and the reoperation rate were compared between the two groups. The incidence of postoperative complications was recorded.

Results

The operation time and postoperative hospital stay of the percutaneous group were longer than those of the transurethral group ( P < 0.05). There was no significant difference in intraoperative blood loss, 24 h postoperative pain score, stone clearance rates on day 3 and day 14 after operation, or the reoperation rate between the two groups ( P > 0.05). Postoperative complications in the two groups were mainly grade I and II. The total incidence of complications in the percutaneous group was significantly lower than that in the transurethral group ( P < 0.05).

Conclusion

Both percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy are effective in the treatment of incarcerated upper ureteral calculi. The former can reduce the incidence of postoperative complications, but the operation time and postoperative hospital stay are longer.

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Most cited references 13

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Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology.

Theodoros Tokas, Thomas Herrmann, Andreas Skolarikos … (2019)

To perform a review on the latest evidence related to normal and pathological intrarenal pressures (IRPs), complications of incremented values, and IRP ranges during endourology.

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Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

Kamal Moufid, Najib Abbaka, Driss Touiti … (2013)

Context: The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources. Aim: The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS). Settings and Design: Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study. Patients and Methods: Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month. Statistical Analysis Used: Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05. Results: The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2 pts). Ten patients (33%) of group 2 experienced failure: Migration to the kidney (3 pts), ureteral perforation (2 pts), tortuosity of the ureter (2 pts), and epithelial polyps (2 patients). Group 1 patients had an average visual analog (VAS) pain score of 47 mm compared with 31 mm in group 2 patients. The mean hospital stay (days) in group 1 was higher than the group 2 (2.27 ± 0.8 vs. 1.67 ± 0.6, respectively; P = 0.01). The mean analgesia requirement for group 1 (paracetamol chlorhydrate + codeine 12 ± 3 g) was significantly more compared with group B (6.8 ± 2 g) (P 0.05). After 1 month, the stone free-rate remained higher in group 1 (95.5% vs. 66.7%, respectively; P = 0.012). Conclusions: In our series, Perc-URS is a safe and efficient treatment option for proximal ureteral stone, especially when the stone size is superior to 15 mm with the presence of moderate or severe hydronephrosis.

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Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy

Henglong Hu, Lu Xu, Shaogang Wang … (2017)

Objective To compare the risk of postoperative ureteral stricture formation following retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL) in patients with proximal ureteral stones. Materials and Methods We retrospectively reviewed the medical records of patients who underwent RPLU or URSL for proximal ureteral stones between April 2011 and May 2015. Patients were allocated into URSL group or RPLU group and the outcomes were compared. Results A total of 201 patients who underwent 209 procedures including 159 URSL and 50 RPLU with a median follow-up of 30 months were included. No significant difference was observed among the two groups in most baseline parameters, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000). Patients in RPLU group had markedly longer operative time (p = 0.000) and longer postoperative hospital stay (p = 0.000). The initial and one-month stone-free rates were significantly higher in the RPLU group (78.6% vs 100%, p = 0.000 and 82.4% vs 100%, p = 0.001, respectively). Patients in the RPLU had a higher complication rate (18.0% vs 9.4%, p = 0.098) and lower ureteral stricture rate (2.5% vs 2.0%, p = 1.000), while the difference was not significant. Further logistic regression model identified RPLU and female sex as independent risk factors for postoperative complication (Odds Ratio[OR] = 3.57, p = 0.035 and OR = 3.57, p = 0.025, respectively); however, URSL was not an independent risk factor for the formation of postoperative ureteral stricture after adjusting confounding variables (OR = 0.90, p = 0.935). Conclusion RPLU and URSL have similar postoperative ureteral stricture formation risks. RPLU can provide significantly higher stone clearance rate, but relates with more postoperative complications.

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Author and article information

Contributors

Honglei Shi:

ORCID: https://orcid.org/0000-0002-7906-8766

Journal

Journal ID (nlm-ta): Emerg Med Int

Journal ID (iso-abbrev): Emerg Med Int

Journal ID (publisher-id): emi

Title: Emergency Medicine International

Publisher: Hindawi

ISSN (Print): 2090-2840

ISSN (Electronic): 2090-2859

Publication date Collection: 2022

Publication date (Electronic): 8 July 2022

Volume: 2022

Electronic Location Identifier: 7651215

Affiliations

Department of Urology, Changzhou Wujin Peoples Hospital, Changzhou, Jiangsu 213000, China

Author notes

Academic Editor: Weiguo Li

Author information

Honglei Shi https://orcid.org/0000-0002-7906-8766

Article

DOI: 10.1155/2022/7651215

PMC ID: 9286973

PubMed ID: 35844464

SO-VID: 404aaca8-582b-49b2-a138-92794310b7e9

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 11 May 2022

Date accepted : 21 June 2022

Funding

Funded by: 2019 Changzhou Eighth Batch of Science and Technology Plan (Science and Technology Support - Social Development)

Award ID: CE201950020

Funded by: Changzhou Wujin District Science and Technology Development Project

Award ID: WS201943

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Retracted: Effects of Stone Removal via Different Approaches in the Treatment of Incarcerated Upper Ureteral Calculi: A Comparative Study
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Effects of Stone Removal via Different Approaches in the Treatment of Incarcerated Upper Ureteral Calculi: A Comparative Study

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Most cited references 13

Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology.

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy

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