Efficacy comparison of 6 different minimal invasive methods in the treatment of upper ureteric stone in 598 cases

Objective: To analyze the clinical effects of the urteroscopic lithotripsy(URL),flexible urteroscopic lithotripsy(fURL),URL combined with N-Trap,extracorporeal shock wave lithotripsy(ESWL),mini-percustaneous nephrolithotomy(mPCNL) and retroperitoneal laparoscopic urterotomy(RLU) in the treatment of upper ureteric stones for providing the reference in selecting the best treatment means of upper ureteric stones.Methods: The clinical data of 186 cases treated with URL,39 cases treated with fURL,149 cases treated with URL combined with N-Trap,131 cases treated with ESWL,58 cases treated with mPCNL and 35 cases treated with PLU were analyzed.Results: The success rates of URL,fURL,URL combined with N-Trap,ESWL,mPCNL and RLU in treating upper ureteric stones were 60.2%,92.3%,89.9%,93.9%,96.6% and 97.1%,respectively.The differences of the success rates of fURL,URL combined with N-Trap,ESWL,mPCNL and RLU in treating upper ureteric stones were not statistically significant(P>0.05),and which was significanly higher than that of URL(P<0.01).The URL,fURL and URL combined with N-Trap were not suitable for the patients with N-shape bending ureter or failure to access below ureteral calculi.The once success rate of ESWL in patients with stone diameter ≤ 10 mm was higher than that in patients with stone diameter >10 mm(P<0.01),and the ESWL was not suitable for patients with polyp or stricture below the ureteral calculi.Conclusions: The once success rate of single-use URL in treating upper ureteral calculi is low,and the fURL or URL combined with N-Trap can improve the success rate of lithotripsy.Selecting the minimal invasive method to treat upper ureteric stone should be based on the stone location,size,complicated with ureter diseases and ureteroscopy auxiliary equipment.