The efficacy and impact on quality of life in the elderly patients with proximal ureteral stones larger than 1 cm who reciveing minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery
Objective To compare the efficacy and impact on the quality of life of elderly patients of minimally invasive percutaneous nephrolithotomy(MPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of unilateral upper ureteral calculi larger than 1.0 cm in diameter.Methods A total of 104 patients were prospectively collected from January 2021 to December 2022 in the First Hospital of Shanxi Medical University.Based on the inclusion and exclusion criteria,88 patients were finally included,32 patients in the MPCNL group and 56 patients in the RIRS group,and the independent samples t-test,X2 test,or Fisher's exact probability method were used to compare the differences in the general information,stone characteristics,and intraoperative and postoperative indexes between the two groups,and the quality-of-life scores were applied with the SF-36 Health Survey form.Results There were no significant differences in age[(67.52±7.41)years and(67.38±7.25)years],gender[male/female:19/13 cases and 36/20 cases],body mass index[(23.74±2.93)kg/m2 and(23.70±2.57)],stone location(left/right:20/12 cases and 38/18 cases),degree of hydronephrosis(mild/moderate/severe:9/20/3 cases and 16/38/2 cases),stone maximum diameter[(14.12±3.69)mm and(13.34±2.99)mm],stone CT values[(1 035.7±275.7)HU and(973.3±253.8)HU]and postoperative complications[15.6％(5/32)and 14.3％(8/56)]bet ween the two groups of patients(P＞0.05).However,there were significant difference in stone clearance rate[96.9％(31/32)vs.80.4％(45/56)],and the operation time[(44.44±9.91)min vs.(54.69±11.94)min]between the two groups.The hospital stay in the RIRS group was shorter than that in the MPCNL group[(5.27±2.27)d vs.(8.00±2.19)d,P＜0.05].There was no significant difference in the scores of eight dimensions between the two groups before surgery(P＜0.05).At the day of discharge,patients in the MPCNL group had significantly lower mean scores than the RIRS group on six different subscales of the SF-36 questionnaire,namely,physical functioning,role-physical,bodily pain,social functioning,role-emotional and mental health.No differences in the mean scores for general health and vitality between the two groups were noted.In terms of SF-36 scores at one month after operation,the MPCNL group had lower scores in physical pain and social function than the RIRS group and the difference was statistically significant(P＜0.05).No differences in the mean scores for other domains at one month after operation between patients undergoing MPCNL and those undergoing RIRS were noted.Conclusions For patients with unilateral upper ureteral calculi larger than 1.0 cm in diameter,MPCNL has higher stone-free rate and shorter operation time than RIRS,but longer hospitalization time,and MPCNL has a greater impact on the quality of life of patients with ureteral calculi than RIRS in many aspects.
Ureteral stonesMinimally invasive percutaneous nephrolithotomyRetrograde intrarenal surgeryQuality of lifeCurative effect
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