Purpose: In this study we compared success rate and complications of two different approaches: Percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy in management of large proximal ureteral stone.
Materials and Methods: In this prospective cohort study the success rate and complications of 52 patients with proximal ureteral stone who had been operated with PCNL by one of the supervisors of this study in Hamadan's Shahid Beheshti Hospital were compared with 55 patients with proximal ureteral stone who had been operated with laparoscopic ureterolithotomy in Tehran's Shahid Labbafi Nejad Hospital.
Results: In PCNL group, the mean age of the patients was 47.78±16.72 years, 75% were male and 25% were female, 50% were in right upper ureter and 50% were in the left upper ureter. The mean duration of surgery was 32±9.4 minutes with a 100% success rate. The stone size was 18.33 ± 2.63 mm and 21.29 ± 2.18 mm in PCNL and laparoscopy groups, respectively showing significant difference (P<0.001). In laparoscopic group, the mean age of the patients was 42.92±16.10 years. 83.6% were male and 16.4% were female. In this group, 46.6% had right and 53.4% had left ureteral stone. The mean duration of surgery was 107.43±22.86 minutes with a 100% success rate. There was not any significant statistical difference between surgery type with variables of age, gender, constitution place of stone, mean duration of hospitalization after surgery, degree of hydronephrosis and success rate (P>0.05); but the duration of surgery in PCNL group was significantly less than laparoscopy group (P<0.001) and decrease in hemoglobin, hematocrit and serum urea in PCNL group were more than laparoscopy group.
Conclusion: PCNL and laparoscopic ureterolithotomy for the treatment of upper ureteral large stones have had some success rate. However, these procedures can be used with respect to hospital facilities, surgical team qualifications, and patient conditions.
Stoller M. Urinary stone disease in; Smith General Urology. San-Francisco, Mc-Graw-Hill. 18th edition. 2012.
Sofer M, Tavdi E, Levi O, Mintz I, Bar-Yosef Y, Sidi A, et al. Implementation of supine percutaneous nephrolithotomy: a novel position for an old operation. Cent European J Urol. 2017; 70(1):60-65.
Mak DK, Smith Y, Buchholz N, El-Husseiny T. What is better in percutaneous nephrolithotomy - Prone or supine? A systematic review. Arab J Urol. 2016; 14(2):101-7.
Pereira-Arias JG, Gamarra-Quintanilla M, Urdaneta-Salegui LF, Mora-Christian JA, Sánchez-Vazquez A, Astobieta-Odriozola A, et al. Current status of extracorporeal shock wave lithotripsy in urinary lithiasis. Arch Esp Urol. 2017; 70(2):263-287.
Bahílo Mateu P, Budía Alba A, Liatsikos E, Trassierra Villa M, López-Acón JD, de Guzmán Ordaz D, et al. Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. Actas Urol Esp. 2017; 41(7):426-434.
Jiang H, Yu Z, Chen L, Wang T, Liu Z, Liu J, et al. Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis. Biomed Res Int. 2017; 2017:2035851.
Rassweiler J, Rassweiler MC, Frede T, Alken P. Extracorporeal shock wave lithotripsy: An opinion on its future. Indian J Urol. 2014; 30(1):73-9.
Elmansy HE, Lingeman JE. Recent advances in lithotripsy technology and treatment strategies: A systematic review update. Int J Surg. 2016; 36(Pt D):676-680.
Kroczak T, Scotland KB, Chew B, Pace KT. Shockwave lithotripsy: techniques for improving outcomes. World J Urol. 2017. doi: 10.1007/s00345-017-2056-y.
Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 11th Edition. Saunder Co. 2015.
Al-Hunayan A, Khalil M, Hassabo M, Hanafi A, Abdul-Halim H. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol. 2011; 25: 975-978.
Wang Q, Guo J, Hu H, Lu Y, Zhang J, Qin B, et al. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One. 2017; 12(2):e0171478.
Moufid K, Abbaka N, Touiti D, et al. Large impacted upper ureteral calculi:A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position. J Endo Urol Ann. 2013; 5(3): 140-146.
Yang T, Liu S, Hu J, Wang L, Jiang H. The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy. Biomed Res Int. 2017; 2017:4832051.
Pillai A, Mathew G, Nachimuthu S, Kalavampara SV. Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures. J Neurosurg. 2017; 17:1-5.
Hsu CS, Wang CJ, Chang CH, Tsai PC, Chen HW, Su YC. Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial. Int Braz J Urol. 2017; 43(3):481-488.
Sartorius B, Behnes M, Ünsal M, Hoffmann U, Lang S, Mashayekhi K, et al. Arterial access-site complications after use of a vascular closure device related to puncture height. BMC Cardiovasc Disord. 2017; 16;17(1):64.
Gökce Mİ, Ibiş A, Sancı A, Akıncı A, Bağcı U, Ağaoğlu EA, et al. Comparison of supine and prone positions for percutaneous nephrolithotomy in treatment of staghorn stones. Urolithiasis. 2017; 45(6):603-608. doi: 10.1007/s00240-017-0977-y.
Liang T, Zhao C, Wu G, Tang B, Luo X, Lu S, et al. Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience. BMC Urol. 2017; 17(1):15.
Tao J, Sheng L, Zhang HJ, Chen R, Sun ZQ, Qian WQ. Acute Abdominal Compartment Syndrome as a Complication of Percutaneous Nephrolithotomy: Two Cases Reports and Literature Review. Urol Case Rep. 2016; 8:12-4.
Jo JK, Autorino R, Chung JH, Kim KS, Lee JW, Baek EJ, et al. Randomized controlled trials in endourology: a quality assessment. J Endourol. 2013;27(8):1055-60.
Aslzare M, Darabi M.R, Shakiba B, et al. Colonic perforation during percutaneous nephrolithotomy: An -18year experience. J Urol. 2014; 8(5-6):323.
Said SH, Al Kadum Hassan MA, Ali RH, Aghaways I, Kakamad FH, Mohammad KQ. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding. Arab J Urol. 2017; 15(1):24-29.
Cicekbilek I, Resorlu B, Oguz U, Kara C, Unsal A. Effect of percutaneous nephrolithotomy on renal functions in children: assessment by quantitative SPECT of (99m)Tc-DMSA uptake by the kidneys. Ren Fail. 2015; 37(7):1118-21.
Simforoosh N, Aminshararifi A, Nouralizadeh A. Difficulties in laparoscopic surgery for urinary stones. In: Kandari, Gill IS, editors. Difficult conditions in laparoscopic urology.1 st ed, London: Springer-Verlag. 2011; Pp. 305-319.
Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol. 2017; 17(1):50.
Simforoosh N, Aminsharifi A. Laparoscopic management in stone disease. Cure Opin Urol. 2013; 23: 169-174.
Demirci D, Gulmez I, Ekmekcioglu O, Karacagil M. Retroperitoneoscopic ureterolithotomy for the treatment of ureteral calculi. Urol Int. 2004;73(3):234-7.
Kim JY, Kang SH, Cheon J, Lee JG, Kim JJ, Kang SG. The usefulness of flexible cystoscopy for preventing double-J stent malposition after laparoscopic ureterolithotomy. BMC Urol. 2017; 15;17(1):44.
Nouira Y, Kallel Y, Bionous MY, Dahmoul H, Horchani A. Laparoscopic retroperitoneal ureterolithotomy :initial experience and review of literature. J Endourol. 2014; 18(6):557-61.
Ergin G, Kirac M, Unsal A, Kopru B, Yordam M, Biri H. Surgical management of urinary stones with abnormal kidney anatomy. Kaohsiung J Med Sci. 2017; 33(4):207-211.
Desai JD. Prospective outcomes of 11-13Ch. ultra-mini percutaneous nephrolithotomy (UMP): A consecutive cohort study. Arch Esp Urol. 2017; 70(1):202-10.
Simforoosh N, Basiri A, Danesh AK, et al. Laparoscopioc management of ureteral calculi: a report of 123 cases. Urol J. 2007; 4(3):138-41.
Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an update evidence – based review. Urol Res. 2010; 38: 44-337.
Skrepetis K, Doumas K, Siafakas I, et al. Laparoscopic versus open ureterolithotomy. A comparative study. Eur Urol. 2001; 40; 32-36.
Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolithotripsy. Int Urol Nephrol. 2003; 76-35:73.
Basiri A, Simforoosh N, Ziaee A, et al. Retrograde, antegrade, and laparoscopic approaches for the management of large proximal ureteral stones: a randomized clinical trial. J Endourol. 2008; 22:2677-2680.
Mousavi-Bahar SH, Minaei MA. Results of PCNL for renal and upper ureteral stones without fluoroscopy. Sci J Hamadan Univ Med Sci. 2003; 10:35-8.
Mousavi Bahar SH, Babolhavaeji H, Mani Kahsani Kh, Zand-Vakili H. Percutaneous Nephrolithotomy in the management of pediatric renal calculi. J Med Counc Iran. 2006; 24(3):271-8.
Mousavi Bahar SH, Babolhavaeji H, Mani Kahsani Kh. Study of response rate to PCNL therapy for renal and upper ureteral stones. J Tabriz Univ Med Sci. 2007; 29(1): 103-9.
Noorbala H. Laparoscopic ureterolithotomy: Results and report of transperitoneal TUL (Laparoscopic assisted). JAUMS. 2006; 4(3):939-42.
Soufi Majidpour H, Yousefinejad V. Percutaneous management of urinary calculi in horseshoe kidneys. Urol J. 2008; 5(3):188-91.
Zhao C, Yang H, Tang H, Xia D, Xu H, Chen Z, et al. Comparison of laparoscopic stone surgery and percutaneous nephrolithotomy in the management of large upper urinary stones: a meta‑analysis. Urolithiasis. 2016; 44(6):479-90.
Aminsharifi A, Irani D, Masoumi M , Goshtasbi B, Aminsharifi A, Mohamadian R. The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome. Urolithiasis. 2016; 44(6):551-7.
Lopez M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol. 2010; 25(1):49–59.