LAUSR

OBJECTIVE To compare the clinical efficacy of Ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) in the treatment of complicated impacted proximal ureteric calculi based on a new scoring standard. METHODS The data of 45 patients with complicated impacted proximal ureteric calculi (score≥3 points) who underwent URSL were collected in this retrospective study between January 2015 and April 2021. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was >2 cm, stone density was >1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was infection. Scores for stones were then assigned (yes = 1, no = 0), and the complicated stone case was defined as a total stone score ≥3 points. During the same period, PCNL was used in 171 patients with complicated impacted proximal ureteric calculi. 45 patients were selected as the control group and matched at a 1:1 ratio to index URSL cases in regard to age, sex, BMI. Perioperative data were compared between the two groups. RESULTS All 90 operations were successfully completed. Compared to the URSL group, the surgical duration of the PCNL group was significantly shorter stone-free rate (SFR) was significantly higher (93.3% vs. 68.9%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs. US $3901.45±1069.46, p < 0.05). Conversely, the URSL group had a shorter hospital stay. There was a significant difference in complication rate between the two groups in regard to Clavien grade I, II, or III complications (20.0% in URSL group vs. 8.9% in PCNL group, p=0.037). CONCLUSION PCNL had a better SFR and higher surgical efficacy, whereas URSL had a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureteric calculi.