Impacted large ureteral stone: What is the best approach?

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5-2.0 cm in diameter

PURPOSE

First research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet.

METHODS

From December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups.

RESULTS

A total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days).

CONCLUSION

Both FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5-2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings.

The influence of perioperative nursing intervention in patients with ureteral calculi treated with URSL and its correlation to adverse event incidence: A retrospective study

To evaluate the effectiveness of perioperative nursing intervention in patients undergoing ureteroscopic lithotripsy (URSL) for ureteral stones and its implications for the incidence of adverse events, a total of 144 patients with ureteral stones admitted to our hospital from January 2021 to December 2022 were selected for retrospective analysis. They were divided into 2 groups based on their different nursing methods, with 72 patients in each group. The control group (CG) received routine nursing intervention, while the study group (SD) received refined perioperative nursing intervention. The surgical situation, effective stone removal rate, postoperative pain, inflammatory factors, stress response, and incidence of adverse events were compared between the 2 groups. In comparison with the CG, the SD demonstrated a significant reduction in gastrointestinal recovery time, urinary catheter removal time, and hospitalization duration, all presenting statistically significant disparities (P < .05). Notably, the SD exhibited a one-time stone removal rate significantly superior to that of the CG (P < .05). Similarly, the postoperative pain index was significantly lower in the SD (P < .05). Pre- and post-surgical serotonin (5-HT) levels in the SD were markedly lower than in the CG (P < .05). Postoperative levels of Interleukin-10 (IL-10), C-reactive protein (CRP), and white blood cells (WBC) were elevated in both groups, and gradually declined as the patients recovered. However, postoperative levels of IL-10, CRP, and WBC were significantly lower in the SD (P < .05). The SD also showed significantly lower levels of malondialdehyde and higher levels of superoxide dismutase (P < .05). Postoperative levels of cortisol, adrenocorticotropic hormone, and norepinephrine were elevated and progressively returned to normal over time, and were significantly lower in the study group (P < .05). Furthermore, the SD experienced a significant reduction in adverse event incidence compared with the CG (P < .05). Implementing refined perioperative nursing interventions for patients undergoing URSL can effectively decrease the incidence of adverse events, diminish the surgical stimulation of inflammation markers and oxidative stress indicators, and foster patient recovery.