EFFICACY AND SAFETY OF URSLAND MINI-PCNL FOR TREATMENT OF IMPACTED LARGE UPPER URETERAL CALCULI: A PROSPECTIVE STUDY.

Abstract

Background: For the management of large impacted upper ureteral calculi, the available minimally invasive endourologic methods are minipercutaneous nephrolithotomy (Mini-PCNL), ureteroscopic lithotripsy (URSL), and laparoscopic ureterolithotomy. This study aimed to compare Mini-PCNLand URSL, and to evaluate the better choice for large impacted upper ureteral calculi. Methods: Between January 2017 and December 2020, at the Urology Unit, Department of Surgery, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Porompat, Imphal, 40 patients with large impacted upper ureteral calculi (>15 mm) who were consecutively enrolled were included. The patients were randomly divided (1:1) into Mini-PCNL and URSL groups. The primary endpoint was the success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications. Results: Eight patients after URSLand 2 patients after Mini-PCNLneeded auxiliary ESWLtreatment. The stone clearance rate in the Mini-PCNL group was 95 % (19/20) and 75 % (15/20) in the URSL group. Operation-related complications were similar among the two groups (all p > 0.05). Hospital stay was shorter in the URSL group compared with Mini-PCNL (p < 0.001). However, the mean operative duration was shorter in the URSLgroup compared to the Mini-PCNLgroup (p < 0.001). Conclusions: Mini-PCNL and URSL are suitable treatment options for impacted upper ureteral calculus with a diameter of >15 mm. Though the success rate and stone clearance rate are lower but acceptable, URSL could be considered if the patient is not suitable for general anesthesia and with other comorbidities, or if it is the patient's preferred treatment option