Department of Urology, The First Hospital of Yulin, Yulin, People's Republic of China.
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
Urolithiasis. 2024 Jul 29;52(1):109. doi: 10.1007/s00240-024-01609-9.
Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15 mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4 g/dL vs. 1.5 ± 0.7 g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15 mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.
嵌顿性近端输尿管结石（IPUS）因其持续性和相关并发症而呈现出具有挑战性的临床情况。虽然输尿管镜碎石术（URS）碎石术被推荐为主要治疗方法，但对于此类结石的最佳治疗方法仍存在争议。在这项回顾性分析中，我们比较了经腹腔腹腔镜输尿管切开取石术（LU）和经皮肾镜取石术（PCNL）治疗大于 15 毫米的 IPUS 的手术结果和长期结果。采用倾向评分匹配（PSM）来减轻潜在的选择偏差。PSM 后，每组 83 名患者的基线特征具有可比性。与 PCNL 相比，LU 的手术成功率更高（100% vs. 96.4%，p=0.244），围手术期血红蛋白下降幅度更小（0.6±0.4 g/dL vs. 1.5±0.7 g/dL，p=0.036）。此外，LU 在术后 2 个月的结石清除率更高（100% vs. 91.6%，p=0.043），但导尿管留置时间更长（7.4±1.2 天 vs. 3.5±2.2 天，p=0.011）。相反，PCNL 与总并发症发生率更高相关（21.7% vs. 9.6%，p=0.033）和在平均 40 个月的随访期间结石复发率更高（20.5% vs. 8.4%，p=0.027）。经腹腔 LU 和 PCNL 是治疗大于 15 毫米的 IPUS 的有效干预措施。值得注意的是，LU 比 PCNL 更具优势，可提供更高的结石清除率、更低的围手术期并发症发生率和更低的复发率。
