The effectiveness of percutaneous nephrolithotomy for the treatment of large impacted upper ureteral stones

Abstract

Objective: To compare the efficacy of semi-rigid or flexible ureteroscopic surgery and percutaneous nephrolithotomy, which is the standard method for the surgery of ≥2 cm upper ureteral impacted stones . Materials and Methods: The data of 123 patients who underwent stone surgery for ≥2 cm impacted ureteral stones in the upper ureter in our clinic were retrospectively analyzed. The patients were divided into two groups as ureteroscopic surgery group (URS, n = 59) and percutaneous nephrolithotomy group (PNL, n = 64) according to the type of operation. Patients with stones impacted in the ureter at the level between the L4 vertebra and ureteropelvic junction were included in the study. Preoperative demographic data and postoperative results of the patients in two groups were compared. Results: Average operation time was similar in both groups (p = 0.147). Mean hospital stay was significantly higher in the PNL group compared to the URS group (3.28 ± 0.57 days vs 1.11 ± 0.32 days, p = 0.001). Mucosal injury was developed in 10 (16.9%) patients in the URS group during the operation, while it was only 3 (4.7%) in the PNL group (p = 0.027). Postoperative urinary tract infection development was found to be similar in URS and PNL groups (8.5% vs 4.7%, p = 0.479). Postoperative stone-free rate was found to be significantly higher in the PNL group compared to the URS group (95.3% vs 79.7%, p = 0.008). Conclusion: PNL is a very effective and safe procedure in the surgical treatment of stones ≥2 cm in diameter impacted in the upper ureter. The complication rate of PNL is comparable with URS; however, it is seen that the PNL is more advantageous than URS in terms of postoperative total stone-free rate.

Keywords

• Urolithiasis
• percutaneous nephrolithotomy
• ureteroscopic surgery

References

1. Brener ZZ, Winchester JF, Salman H, Bergman M. Nephrolithiasis: evaluation and management. South Med J 2011; 104: 133–9.
2. Yasui T, Okada A, Hamamoto S, al. Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function. Springerplus 2013; 2: 600.
3. Lee YH, Tsai JY, Jiaan BP, et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology 2006; 67: 480–4.
4. Vanlangendonck R, Landman J. Ureteral access strategies: pro-access sheath. Urol Clin North Am 2004; 31: 71–81.
5. Turk C, Knoll T, Petrik A, et al. Guidelines on urolithiasis. European Association of Urology 2014. http: //www.uroweb.org/gls/pdf/22%20Urolithiasis_LR.pdf. Accessed February 25, 2015.
6. Kadyan B, Sabale V, Mane D, et al. Large proximal ureteral stones: ideal treatment modality? Urol Ann 2016; 8: 189–92.
7. Ferakis N, Stavropoulos M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: lessons learned from a review of the literature. Urol Ann 2015; 7: 141–8.
8. Lee JW, Park J, Lee SB, Son H, Cho SY, Jeong H. Mini-percutaneous Nephrolithotomy vs retrograde Intrarenal surgery for renal stones larger than 10 mm: a prospective randomized controlled trial. Urology 2015; 86: 873–7.

9. Hussain M, Ali B, Ahmed S, et al. Prediction of renal function recovery in obstructive renal failure due to stones. J Pak Med Assoc 1997; 47: 159–61.
10. Lee JY, Han JH, Kim TH, et al. Laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease: the first 30 cases in a multicenter study. J Endourol 2011; 25: 1293-8.
11. McAteer JA, Evan AP. The acute and long-term adverse effects of shock wave lithotripsy. Semin Nephrol 2008; 28: 200–13.
12. Mugiya S, Ozono S, Nagata M, et al. Retrograde endo-scopic management of ureteral stones more than 2 cmin size. Urology 2006; 67: 1164–8.
13. Segura JW, Preminger GM, Assimos DG, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 1997; 158: 1915–21.
14. Seitz C, Tanovic E, Kikic Z, et al. Impact of stone size, location, composition, impaction and hydronephrosis on the efficacy of holmium: YAG-laser ureterolithotripsy. Eur Urol 2007; 52: 1751–9.
15. Lai D, Chen M, He Y, Li X. Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal. BMC Urol 2015; 19: 15-22.
16. Xiao-jian G, Lin LJ, Yan X. Treatment of large impacted proksimal ureteral stones: Randomized comparison of minimally invasive percutenous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol 2013; 31: 1605–10.
17. Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 2005; 19: 54–7.
18. Juan YS, Shen JT, Li CC, Wang CJ, Chuang SM, Huang CH, Wu WJ. Comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the management of impacted, large, proximal ureteral stones. Kaohsiung J Med Sci 2008; 24: 204-9.
19. Yang Z, Song L, Xie D, et al. Comparative study of outcome in treating upper ureteral impacted stones using minimally invasive percutaneous nephrolithotomy with aid of patented system or transurethral ureteroscopy. Urology 2012; 80: 1192-7.
20. Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol 2017; 17: 50.
21. Bozkurt IH, Yonguc T, Arslan B, et al. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy? Can Urol Assoc J 2015; 9: 122-5.