Mini-Percutaneous Nephrolithotomy is the Optimal Treatment for Proximal Impacted Ureteral Stones Wrapped with the Ureteral Polyps Compared to Ureteroscopic Lithotripsy

Haimin Zhang1#, Changcheng Guo1#, Wei-Guo Ma2#, Guangchun Wang1, Pengfei Wu1, Yang Yu1, Xudong Yao1* and Yunfei Xu1*

1Department of Urology, Shanghai Tenth People’s Hospital, Tongji University, China
2Department of Urology, Tongxin People's Hospital, China
#These authors contribute equally to this work as the co-first authors

^*Correspondance to: Yunfei Xu 

 PDF  Full Text DOI: 10.25107/2474-1647.3458

Abstract

Objective: To compare the safety and effectiveness between Ureteroscopic Lithotripsy (URSL) and Mini-Percutaneous Nephrolithotomy (MPCNL) to treat 1 cm to 2 cm proximal impacted ureteral stone wrapped with inflammatory ureteral polyps stones. Methods: A retrospective study was performed to analysis the outcomes from the prospectively maintained stone patients database. Only patients undergoing URSL and MPCNL for 1 cm to 2 cm ureteral stones wrapped with ureteral polyps were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analyzed. Results: A retrospective patient cohort was reviewed and compared URSL (n=147) and MPCNL (n=129). MPCNL group obtained a higher initial SFR (99.22% vs. 65.99%, p<0.05) in a shorter lithotripsy time (17.7 min ± 8.7 min vs. 45.3 min ± 9.6 min, p<0.05) compared to URSL group. The URSL group had higher fever rate (8.16% vs. 4.65%) and more urosepsis (1.36% vs. 0%) than the MPCNL group, but there was no statistical significance. Four patients occurred subscapular hematoma in MPCNL group, and one patient need blood transfusion, but there is no statistical significance compared to URSL group. In terms of ureteral stricture, MPCNL had a lower ureteral stricture rate compared to URSL group (5.44% vs. 0.78%, p<0.05). But MPCNL need longer hospital stays than URSL (7.2 ± 1.2 days vs. 2.6 ± 0.7 days, p<0.05). Conclusion: Although generally MPCNL occurred more subscapular hematoma compared to URSL, for 1 cm to 2 cm proximal ureteral stones wrapped with ureteral polyps, MPCNL can be first considered because it can achieve a higher initial SFR in a shorter lithotripsy time and lower ureteral stricture rate despite of more subscapular hematoma and longer hospital stays.

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Cite the article

Zhang H, Guo C, Ma W-G, Wang G, Wu P, Yu Y, et al. Mini-Percutaneous Nephrolithotomy is the Optimal Treatment for Proximal Impacted Ureteral Stones Wrapped with the Ureteral Polyps Compared to Ureteroscopic Lithotripsy. Clin Surg. 2022; 7: 3458..