Comparative Study of Three Kinds of Minimally Invasive Lithotripsy for Treatment of Impacted Upper Ureteric Calculi

Objective To compare the efficacy and safety of transurethral ureteroscope lithotripsy(URL),the minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneal laparoscopic ureterolithotomy(RPLU) in treating impacted upper ureteric calculi.Methods 116 patients with impacted upper ureteric calculi were treated with URL,MPCNL and RPLU respectively.The operating time,postoperative hospital staying time,complications and postoperative stone clearance rate in 3 days and one month of three groups were compared and analyzed.Results There was statistical significance of the operation time in the three groups(MPCNL group URL group RPLU group,all P 0.01).There was no statistical significance of the operation related complications in the three groups(P 0.05).There was statistical significance of the postoperative hospital stay time in the three groups(RPLU group URL group MPCNL group,P 0.01 or P 0.05).In comparison of the rate of needing treatment of extracorporeal shock wave lithotripsy(ESWL),the stone free rate in 3 days and one month postoperation,MPCNL group or RPLU group was better than URL group(P 0.01 or P 0.05),but there was no statistical significance between MPCNL group and RPLU group(all P 0.05).Conclusions MPCNL may be the better choice for impacted upper ureteric calculi which is larger,higher and follows obvious hydronephrosis.URL is better for the patients whose ureteric calculi is smaller,lower or the patients who claim to accept postoperative ESWL.RPLU is suitable for patients with impacted upper ureteric calculi who are difficult for MPCNL or URL,and as a salvage procedure after failed ESWL,URL or MPCNL.