Purpose:
The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography.
Results:
A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P < 0.0001); and the average hospital stay days were 2.6 (22. Hemal AK, Goel A, Goel R: Minimally invasive retroperitoneoscopic ureterolithotomy. J Urol. 2003; 169: 480-2.
3. Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP: Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005; 19: 54-7.
4. Goel A, Hemal AK: Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy. BJU Int. 2001; 88: 679-82.-55. Park H, Park M, Park T: Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol. 1998; 12: 501-4.) and 3.5 (33. Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP: Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005; 19: 54-7.
4. Goel A, Hemal AK: Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy. BJU Int. 2001; 88: 679-82.
5. Park H, Park M, Park T: Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol. 1998; 12: 501-4.
6. Erhard M, Salwen J, Bagley DH: Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. 1996; 155: 38-42. Erratum in: J Urol 1996; 155: 1039.
7. Mugiya S, Nagata M, Un-No T, Takayama T, Suzuki K, Fujita K: Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor. J Urol. 2000; 164: 329-31.-88. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW: Ureteroscopy: current practice and long-term complications. J Urol. 1997; 157: 28-32.) days (p = 0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups.
Conclusion:
According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.
Urinary Calculi; Nephrostomy, Percutaneous; Laparoscopy; Ureteral Calculi