Comparative study between retroperitoneal laparoscopic ureterolithotomy and ureteroscopic laser lithotripsy in the treatment of incarcerated stones in the upper ureter
Objective:To further explore the difference between retroperitoneal laparoscopic ureterolithotomy(RPLU)and ureteroscopic lithotripsy(URSL)in the treatment of upper ureteral incarcerated stones.Methods:One hundred and sixteen patients with incarcerated upper ureteral stones admitted to our department from January 2018 to August 2021 were divided into the RPLU group(67 cases)and the URSL group(49 cases).Among the patients,there were 64 males and 52 females with an average age of(39.2±7.8)years.The main parameters such as diameter of the stones,preoperative urine leukocyte and bacterial count,preoperative renal glomerular fil-tration rate(GFR)in the affected side,operative time,postoperative fever rate,surgical complications rate,CT value of stones and stone removal rate were compared and analyzed.Results:All patients were successfully opera-ted.There was no significant difference between the two groups in terms the diameter of the stones([1.7±0.3]cm vs[1.8±0.4]cm,P=0.214),CT value of stones([549.7±37.2]HU vs[554.6±43.7]HU,P=0.183),preoperative urinary bacteria count([103.4±13.6]/μL vs[112.9±17.5]/μL,P=0.173),preoperative leuko-cyte count([315.9±27.9]/μL vs[348.6±36.2]/μL,P=1.05),or renal GFR in the affected side([25.6± 9.8]mL/min vs[28.2±11.4]mL/min,P=0.097).Also,there was no significant difference in operative time between the RPLU group and the URSL group([70.9±17.7]min vs[63.6±13.1]min,P=0.237).Although the URSL group had less intraoperative blood loss([53.5±12.9]mL vs[37.2±14.1]mL,P=0.033),postop-erative hospital stay([7.3±0.9]days vs[4.9±1.1]days,P=0.041)and postoperative VAS scores([6.4± 1.7]scores vs[4.3±1.4]scores,P=0.011)than the RPLU group,the RPLU group was superior to the URSL group in terms of postoperative fever rate(7.5％vs 16.3％,P=0.006)and total hospitalization expenses([15 707.7±535.4]Yuan vs[17 384.1±474.8]Yuan,P=0.038)after surgery.In terms of postoperative com-plications,the RPLU group was significantly less than the URSL group(17.9％vs 46.9％,P＜0.001).The re-sults of three postoperative examinations showed that the stone clearance rate of the RPLU group was significantly higher than that of the URSL group:the first week(94.0％vs 79.6％,P=0.018),the first month(97.0％vs 83.7％,P=0.001),and the third month(98.5％vs 87.8％,P=0.016).Conclusion:Compared with URSL group,RPLU is more effective in reducing postoperative infection and improving stone clearance.For some pri-mary hospitals of urology,RPLU may be a better choice for dealing with such stones.
ureteral calculilaparoscopicholmium lasersurgeryclinical study
NETL
NSTL
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