[Effects of retroperitoneal laparoscopic ureterolithotomy and flexible-ureteroscopic holmium laser lithotripsy for complex upper ureteral calculi].

To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with test and χ(2)test. The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes .(73.3±11.3) minuetes, =0.61, =0.67), time of double J tube removed ((33.8±3.4)days . (37.6±8.9) d, =2.37, =0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes .(40.5±7.1) ml/min, =0.78, =1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days . (4.2±1.6) days, =1.92, =0.04), postoperative fever rates (4% .30%, χ(2)=5.72, =0.03) and calculus clearance rates (100% . 75%, χ(2)=7.03, =0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.