Xie Xi, Xie Guoping, Li Wei, Taguchi Kazumi, Somani Bhaskar, Yuan Yuan, Li Bo
Department of Urology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Transl Androl Urol. 2025 Aug 30;14(8):2375-2382. doi: 10.21037/tau-2025-277. Epub 2025 Aug 25.
Urinary stones are a common disease in urology, and stones in ureteral strictures can easily lead to obstruction and subsequent infection. If the upper ureteral impacted stones with infection are not treated promptly, further renal impairment and urinary sepsis can occur. Mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (fURSL) are common methods for the treatment of upper ureteral impacted stones with infection, but their superiority remains debated. To this end, we designed this study to compare the effects of mini-PCNL versus fURSL in patients with upper ureteral impacted stones with infection.
The data of 182 patients with upper ureteral impacted stones and infection admitted to The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2024 were retrospectively collected. The patients were divided into an antegrade group (n=88) and a retrograde group (n=94) according to the method they received. The antegrade group was treated with minimally invasive PCNL, and the retrograde group was treated with fURSL. The main outcome measure included inflammatory markers [white blood cell count (WBC), C-reactive protein, interleukin 6, and procalcitonin], and renal function (serum creatinine and urea nitrogen). The other indicators included surgery-related outcomes (operation time and stone-free status) and postoperative complications.
Compared with the retrograde group, the one-time stone clearance rate in the antegrade group was significantly higher (96.59% 86.17%; P=0.03). Compared with that in the retrograde group, the operation time in the antegrade group was significantly longer (62.73±4.82 51.84±5.02 min; P<0.001). There were no statistically significant differences in leukocyte, C-reactive protein, or interleukin 6 levels between the two groups before treatment (P>0.05). Compared to the retrograde group 3 days after surgery, the antegrade group had a significantly higher WBC [(10.92±2.88 8.92±2.62)×10/L; P<0.001], C-reactive protein (12.94±4.72 10.82±4.82 mg/L; P=0.003), and interleukin 6 level (18.74±9.82 15.81±9.27 ng/L; P=0.04). There was no statistically significant difference in postoperative complications between the two groups (P>0.05).
PCNL can improve stone clearance rate, but the operation time is long and relatively invasive.
尿路结石是泌尿外科的常见疾病，输尿管狭窄处的结石容易导致梗阻及随后的感染。如果上段输尿管嵌顿结石合并感染未得到及时治疗，可能会出现进一步的肾功能损害及尿脓毒症。微创经皮肾镜取石术（PCNL）和软性输尿管镜碎石术（fURSL）是治疗上段输尿管嵌顿结石合并感染的常用方法，但它们的优势仍存在争议。为此，我们设计了本研究，比较微创PCNL与fURSL治疗上段输尿管嵌顿结石合并感染患者的效果。
回顾性收集2021年1月至2024年12月成都医学院第一附属医院收治的182例上段输尿管嵌顿结石合并感染患者的数据。根据患者接受的治疗方法将其分为顺行组（n = 88）和逆行组（n = 94）。顺行组采用微创PCNL治疗，逆行组采用fURSL治疗。主要观察指标包括炎症标志物[白细胞计数（WBC）、C反应蛋白、白细胞介素6和降钙素原]以及肾功能（血清肌酐和尿素氮）。其他指标包括手术相关结果（手术时间和结石清除情况）及术后并发症。
与逆行组相比，顺行组的一次性结石清除率显著更高（96.59% 对86.17%；P = 0.03）。与逆行组相比，顺行组的手术时间显著更长（62.73±4.82对51.84±5.02分钟；P < 0.001）。两组治疗前白细胞、C反应蛋白或白细胞介素6水平差异无统计学意义（P > 0.05）。与术后3天的逆行组相比，顺行组的WBC水平显著更高[（10.92±2.88对8.92±2.62）×10⁹/L；P < 0.001]、C反应蛋白水平（12.94±4.72对10.82±4.82 mg/L；P = 0.003）和白细胞介素6水平（18.74±9.82对15.81±9.27 ng/L；P = 0.04）。两组术后并发症差异无统计学意义（P > 0.05）。
PCNL可提高结石清除率，但手术时间长且创伤相对较大。
