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Zhu X et al, 2013: Retrograde, Antegrade, and Laparoscopic Approaches to the Management of Large Upper Ureteral Stones After Shockwave Lithotripsy Failure: A Four-Year Retrospective Study

Zhu H, Ye X, Xiao X, Chen X, Zhang Q, Wang H
Department of Urology, General Hospital of Armed Police Forces of China , Beijing, China


Abstract

ABSTRACT PURPOSE: We compare the success rate and complications of retrograde ureteroscopy, laparoscopic ureterolithotomy, and percutaneous nephrolithotomy for the management of large upper ureteral stones.

PATIENTS AND METHODS: We retrospectively analyzed data from 73 patients with large (≥1 cm) upper ureteral stones at 2 institutions from January 2010 to May 2013. Twenty-two patients underwent retrograde ureteroscopy (group ULS), 30 patients underwent percutaneous nephrolithotripsy (group PCNL), and 21 patients underwent laparoscopic ureterolithotomy (group LS) for removal of upper ureteral stones. Computed tomography, intravenous urography, and ultrasound were performed 1 week and 1 month after surgical removal.

RESULTS: There were no significant differences in age, sex, or stone size among the 3 groups. Mean estimated blood loss and mean hospital stay showed a statistically significant difference among 3 groups. Success rates in the PCNL, LS, and ULS groups were 100%, 90.5%, and 77.3%, respectively. Two patients in group LS were converted to receiving open surgery because of the inability to find the ureteral stone in 1 patient and an adhesion too difficult to dissect in the other. Two patients in the ULS group were converted to LS, and 3 patients were converted to PCNL due to severe edema impaction at the site of the stone, a sharply angulated ureter obstruction, upward migration of the stone (7 patients), and intraoperative complications (2 patients).

CONCLUSIONS: Percutaneous antegrade nephrolithotomy is a safe and effective minimally invasive treatment for large upper ureteral stones that has several advantages over retrograde ureteroscopy and laparoscopic ureterolithotomy. Thus, percutaneous antegrade nephrolithotomy is recommended as a safe and good treatment option for large upper ureteral stones. A combined procedure (e.g., ureteral push-back and percutaneous removal) can be considered in some patients.

J Endourol. 2013 Oct 4. [Epub ahead of print]
PMID:23914784 [PubMed - as supplied by publisher]

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Comments 1

Peter Alken on Friday, 11 October 2013 13:56

There is no information on the details of the primary SWL treatment and the reasons for failures.

Peter Alken

There is no information on the details of the primary SWL treatment and the reasons for failures. Peter Alken
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