針對近端大輸尿管結石的治療中經皮腎造廔碎石手術以及開放性

或腹腔鏡輸尿管切開取石手術比較

黃昱凱¹, 陳威任^1,2,3, 林登龍^1,2,3, 黃志賢^1,2,3, 黃逸修^1,2,3, 鍾孝仁^1,2,3,

林子平^1,2,3, 黃奕燊^1,2,3, 魏子鈞^1,2,3, 黃子豪^1,2,3, 顧明軒^1,2,3, 許自翔^1,2,3

¹泌尿部 臺北榮民總醫院

²書田泌尿科學研究中心

 ³國立陽明交通大學醫學院泌尿學科

Percutaneous nephrolithotomy versus laparoscopic or open ureterolithotomy in the treatment of large proximal ureteral stone

Yu-Kai Huang¹, Wei-Jen Chen^1,2,3, Alex Teng-Lung Lin^1,2,3, William JS Huang^1,2,3, Eric Yi-Hsiu Huang^1,2,3, Hsiao-Jen Chung^1,2,3, Tzu-Ping Lin^1,2,3, I-Shen Huang^1,2,3, Tzu-Chun Wei^1,2,3, Tzu-Hao Huang^1,2,3, Ming-Hsuan Ku^1,2,3, Tzu-Hsiang Hsu^1,2,3

¹Department of Urology, Taipei Veterans General Hospital

²Shu-Tien Urological Science Research Centerand Department of Urology,

³School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose: Large proximal ureteral stones (>1cm) can lead to severe obstructive uropathy and impaired renal function. The management of such stones includes various approaches such as ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), open or laparoscopic ureterolithotomy. However, URSL may fail in cases with tortuous ureters or ureteral strictures. Therefore, PCNL, open or laparoscopic ureterolithotomy are considered alternatives. This study aims to determine which method yields better outcomes with fewer complications.

Materials and Methods: Between 2015 and 2023, a total of 62 patients with large proximal ureteral stones (>1cm) or those who had previously failed URSL were included in this retrospective study. Among them, 32 patients underwent PCNL, while 30 patients underwent open or laparoscopic ureterolithotomy. Data on stone size, stone-free rates, operation duration, post-operative renal function, peri-operative complications, and length of hospital stay were collected. These data were compared between the PCNL group and the open or laparoscopic ureterolithotomy group using the Two-sample t-test and Pearson's chi-squared test. Additionally, pre-operative and post-operative estimated glomerular filtration rates (eGFR) were analyzed in each group using the paired sample t-test.

Results: Among the 62 patients, the mean age was 60.06 years (range 34 to 91 years) in the PCNL group and 57.80 years (range 34 to 78 years) in the open or laparoscopic ureterolithotomy group. The Two-sample t-test revealed a significant difference in the length of the operation (t=-3.785, p<0.001) and the duration of hospital stay (t=-6.924, p<0.001) between the two groups. Pearson's chi-squared test indicated no significant difference in stone-free rates (p=0.264) or post-operative residual hydronephrosis (p=0.893). The paired t-test showed no significant difference between pre- and post-operative eGFR in each group (p=0.053 in the PCNL group, p=0.107 in the open or laparoscopic ureterolithotomy group). Few peri-operative complications were reported, including blood transfusion (3.1%, 1/32 and 6.7%, 2/30), post-operative ureteral stricture (3.1%, 1/32 and 3.3%, 1/30), and no cases of urosepsis were noted after the operation.

Conclusions: In summary, the PCNL group demonstrated significantly shorter operation duration and hospital stay compared to the open or laparoscopic ureterolithotomy group. However, there was no significant difference between the two groups in terms of stone-free rates or post-operative residual hydronephrosis. Both groups did not show a significant improvement in renal function after the operation, and there were few reported complications. PCNL is an efficient option for patients with large proximal ureteral stones or those who have had a previous failed URSL in order to achieve optimal outcomes.