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Liu Y et al, 2014: Clinical observation of different minimally invasive surgeries for the treatment of impacted upper ureteral calculi.

Liu Y, Zhou Z, Xia A, Dai H, Guo L, Zheng J
Department of Urinary Surgery, First Affiliated Hospital of Yangtze University, Jingzhou 434000, P. R. China.

Abstract

Objective: To compare the clinical effects of three minimally invasive surgeries on the treatment of impacted upper ureteral calculi. Methods: 135 patients with impacted upper ureteral calculi were selected and randomly divided into three groups (Group A-C) (n=45), which were treated with transurethral ureteroscopic lithotripsy, minimally invasive percutaneous nephrolithotomy, and retroperitoneal laparoscopic ureterolithotomy respectively. Relevant results of the three groups were compared. Results: The surgery time of Group C was significantly longer than those of
Group A and Group B (P < 0.05). The postoperative hospitalization time of Group B was significantly longer than those of Group A and Group C (P < 0.05). 37.78% (17/45) of Group A patients required extracorporeal shock wave lithotripsy, being significantly more than those in Group B (6.67%, 3/45) and Group C (0, 0/45) (P < 0.05). The postoperative calculus clearance rate of Group A (51.11%, 82.22%) was significantly lower than those of Group B (91.11%, 97.78%) and Group C (93.33%, 100%) (P < 0.05). The incidence rates of postoperative complications in Group A-C were 11.11% (5/45), 8.89% (4/45) and 6.67% (3/45) respectively without significant differences (P > 0.05). Conclusion: The three surgical methods for impacted upper ureteral calculi should be selected according to practical conditions to improve therapeutic effects and to ensure safe surgery. 

Pak J Med Sci. 2013 Nov;29(6):1358-62.

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Comments 1

Hans-Göran Tiselius on Tuesday, 26 August 2014 11:33

This article only compared ureteroscopic (URS), percutaneous (PNL) and laparoscopic methods for removal of upper ureteral stones that had been in place between 4.2 and 5.5 months! SWL was necessary as an auxiliary procedure in order to complete the treatments in 38% of the patients primarily treated with URS and in 7% of those treated with PNL methods. It had indeed been of interest if the authors had added SWL as a primary procedure for a gropu of these impacted stones. But although the authors had access to SWL, this technique was used only as a complement to URS and/or PNL.

This article only compared ureteroscopic (URS), percutaneous (PNL) and laparoscopic methods for removal of upper ureteral stones that had been in place between 4.2 and 5.5 months! SWL was necessary as an auxiliary procedure in order to complete the treatments in 38% of the patients primarily treated with URS and in 7% of those treated with PNL methods. It had indeed been of interest if the authors had added SWL as a primary procedure for a gropu of these impacted stones. But although the authors had access to SWL, this technique was used only as a complement to URS and/or PNL.
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