Four minimally invasive treatment methods for proximal ureteral stones：experiences from 1 275 patients

Abstract:

Objective：To compare extracorporeal shockwave lithotripsy（SWL），rigid ureteroscopy（RURS），flexible ureteroscopy（FURS） and percutaneous nephrolithotomy（PCNL） and to determine which method was appropriate for proximal ureteral stones. Methods：During six-year period，1 275 patients with proximal ureteal stones were prospectively selected and assigned into groups of SWL，RURS，FURS and PCNL on the basis of patients’ choice. Each group was allocated into three subgroups according to stone size，du－ration and dilated ureter diameter. Stone-free rate，recurrence rate and complication rate were analyzed. Results：Regarding stone-free rate，RURS was higher than SWL while lower than FURS and PCNL（P<0.01）. As for recurrence rate，there’s no difference among RURS，FURS and PCNL（P>0.01）；recurrence rate was lower in RURS，FURS，PCNL than in SWL（P<0.01）. When looking at com－plication rate，there’s no difference among three subgroups of stone size < 1 000 mm3，duration < 3 months and dilated ureter diameter <10 mm（P >0.05）；in the subgroup of stone size≥1 000 mm3，RURS was higher than SWL，FURS and PCNL（P<0.01）；in the subgroup of duration≥3 months，SWL was higher than RURS，FURS and PCNL（P<0.01）；in the subgroup of dilated ureter diameter≥10 mm，FURS and PCNL was lower than SWL and RURS（P<0.01）. Conclusion：Stone size，duration and dilated ureter diameter should be taken into consideration to determine which approach is appropriate. SWL remains the first-choice in the combination of stone size <1 000 mm3，duration < 3 months and dilated ureter diameter<10 mm. PCNL should be the most appropriate approach in the combination of stone size≥1 000 mm3，duration≥3 months and dilated ureter diameter≥10 mm. RURS should be the least preferred single ap－proach for stone size≥1 000 mm3. SWL is not recommended any more for duration≥3 months alone.