Effect of three kinds of minimally invasive surgery for treatment of impacted upper ureteric calculi

Objective To compare the effecacy of minimally invasive treatment of impacted upper ureteric calculi by transureteroscopic lithotripsy (URL), minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU). Methods 69 cases of impacted upper ureteric calculi who were treated in our hospital from December 2013 to December 2017 were retrospectively analyzed, 23 cases were treated by URL, 26 cases by MPCNL and 20 cases by RLU. Results There was no significant difference in age, stone position, stone size and hydronephrosis in the three groups (P>0.05). The operative time and postoperative hospital stay of the three groups were (34±11) min and (3.2±2.5) d in URL group, (59±12) min and (5.5±2.2) d in MPCNL group, (122±25) min and (8.3±2.1) d in RLU group, the difference were statistically significant between the three groups (P<0.05). The success rate and stone clearance rate of the three groups were 82.6% (19/23) and 78.3% (18/23) in URL group, 100% (26/26) and 100% (26/26) in MPCNL group, 95% (19/20) and 100% (20/20) in RLU group, the difference among URL and the other two groups were statistically significant (P<0.05). Conclusions MPCNL has the characteristics of short operation time, high success rate and high stone clearance rate, which is effective in the treatment of incarcerated upper ureteral calculi, MPCNL can be the first choice of treatment if combined with renal calculi. URL is not recommended as the first treatment for upper ureteral calculi. RLU can be used as a selective treatment for upper ureteral calculi. Key words: Ureteric calculi; Ureteroscope; PCNL; Laparoscopy