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Percutaneous nephrolithotomy versus laparoscopic approach in management of large proximal ureteral stone: the experience of two different institutions

Seyed Habibollah Mousavi Bahar, Shahriar Amirhassani, Akbar Nouralizadeh, Nikan ZerafatJou, Jaber Rasiuli



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.


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DOI: http://dx.doi.org/10.22037/uj.v0i0.4538


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