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Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections

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Abstract

The aim of this study is to compare the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopic holmium laser lithotripsy (UHLL) as two minimally invasive procedures in managing obstructive upper ureteral calculi with concurrent urinary tract infections (UTI). The retrospective study included 189 patients who underwent unilateral obstructive upper ureteral stones with concurrent UTI from January 2007 to November 2014 at our institution. Patients received RPLU (81 cases) or UHLL (108 cases). All patients received preoperative anti-infection treatment (indwelling ureteral stent and/or preoperative antibiotics). Collected data, including sex, age, stone size, success rate, operation duration, post-operation hospitalization time, and post-operation complications, were compared. All patients were followed up for more than 6 months after surgeries, and no ureterostenosis occurred. The study included 189 patients, 41 (21.7 %) females and 148 (78.3 %) males with a medium age of 52 years (range 22–81 years). All surgeries were successfully performed without conversion to open surgery. Stone size in the RPLU group was larger than that of the UHLL group (16.1 ± 1.4 vs. 10.4 ± 1.6 mm, P = 0.012). Operative duration (P = 0.009) and hospitalization time (P < 0.001) in the UHLL group were significantly shorter than those in the RPLU group, whereas stone clearance rate was significantly higher in the RPLU group (100 vs. 88.9 %, P = 0.002). Of note, postoperative fever was more common in patients treated with UHLL (15 cases) versus RPLU (4 cases) (13.9 vs. 4.9 %, P = 0.043). Moreover, in the UHLL group, three patients without a preoperative indwelling ureteral stent were complicated with sepsis, which was not seen in RPLU group. In our study, the safety and stone clearance rate of RPLU are better than those of UHLL in the treatment of unilateral upper ureteric calculi with concurrent UTI. Preoperative antibiotics and indwelling ureteral stent may reduce the risk of postoperative infections.

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Abbreviations

RPLU:

Retroperitoneal laparoscopic ureterolithotomy

UHLL:

Ureteroscopic holmium laser lithotripsy

UTI:

Urinary tract infection

ESWL:

Extracorporeal shock wave lithotripsy

CTU:

CT urogram

IVU:

Intravenous urogram

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Authors’ contribution

Xiao-Wen Sun and Shu-jie Xia designed and developed the study. Jun-Tao Jiang drafted the manuscript and participated in data collection. Wei-Guo Li and Yi-Ping Zhu edited the manuscript and participated in data management and analysis. Wen-Lan Sun, Wei-Zhao, and Yuan Ruan participated in data collection. Chen Zhong and Hai-Bin Wei participated in data analysis. Kristofer Wood revised the English of the whole manuscript. All authors have read and approved the final manuscript.

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    Authors and Affiliations

    1. Department of Urology, Shanghai First People’s Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China

      Jun-Tao Jiang, Wei-Guo Li, Yi-Ping Zhu, Wei Zhao, Yuan Ruan, Chen Zhong, Shu-Jie Xia & Xiao-Wen Sun

    2. Department of Geriatrics, Shanghai First People’s Hospital affiliated to Shanghai Jiaotong University, 100 Haining road, Shanghai, 200080, China

      Wen-Lan Sun

    3. Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA

      Kristofer Wood

    4. Department of Urology, Zhejiang Provincial People’s Hospital, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China

      Hai-Bin Wei

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    1. Jun-Tao Jiang
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    Jun-Tao Jiang, Wei-Guo Li, Yi-Ping Zhu and Wen-Lan Sun contributed equally to this work. This research is supported by program from the Science and Technology Commission of Shanghai Municipality (Grant No. 13DZ1940603).

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    Jiang, JT., Li, WG., Zhu, YP. et al. Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections. Lasers Med Sci 31, 915–920 (2016). https://doi.org/10.1007/s10103-016-1932-9

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