Kaohsiung Journal of Medical Sciences
Volume 24, Issue 4 , Pages 204-209, April 2008

Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy in the Management of Impacted, Large, Proximal Ureteral Stones

  • Yung-Shun Juan

      Affiliations

    • Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Jung-Tsung Shen

      Affiliations

    • Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Ching-Chia Li

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Chii-Jye Wang

      Affiliations

    • Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Shu-Mien Chuang

      Affiliations

    • Department of Anatomy, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Chun-Hsiung Huang

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Wen-Jeng Wu

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Wen-Jeng Wu, Department of Urology, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan

Received 29 December 2006; accepted 25 April 2007.

Article Outline

The optimal treatment for large, impacted, proximal ureteral stones remains controversial. We report our experience and compare treatment outcomes in patients with single, impacted, proximal ureteral stones undergoing percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL). Between January 2005 and January 2006, a total of 53 consecutive patients with solitary, impacted, proximal ureteral stones > 15 mm in diameter who had undergone PCNL or URSL treatments were enrolled in this study. The mean age was 48.5 ± 11.8 years. PCNL and URSL were performed in 22 and 31 patients. Stone burdens in the PCNL and URSL groups were 232.8 ± 113.2 mm2 and 150.3 ± 70.3 mm2, respectively. The efficiency quotient (EQ) for the PCNL and URSL groups was 0.95 and 0.67, respectively. The stone-free rate at the 1 month follow-up was 95.4% in the PCNL group and 58% in the URSL group (p < 0.001). Two patients in the PCNL group had blood loss requiring transfusion. Eight patients had stones showing upward migration during the URSL procedure, and these stones were subsequently treated by extracorporeal shock wave lithotripsy and PCNL. For an impacted, proximal ureteral stone > 15 mm in diameter, PCNL had better stone-free rates and could simultaneously treat coexisting renal stones. However, URSL had the advantages of shorter operative times, shorter postoperative hospital stays, and fewer postoperative complications.

Key Words:  percutaneous nephroscopy , ureteral stone , ureteroscopy

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PII: S1607-551X(08)70118-9

doi:10.1016/S1607-551X(08)70118-9

Kaohsiung Journal of Medical Sciences
Volume 24, Issue 4 , Pages 204-209, April 2008

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