The optimal management of large upper ureteral stones (> 1.5 cm) with infection in elderly patients: a comparative analysis of three minimally invasive surgical approaches.

IF 1.8 4区 医学 Q3 UROLOGY & NEPHROLOGY International Urology and Nephrology Pub Date : 2025-01-01 Epub Date: 2024-08-01 DOI:10.1007/s11255-024-04176-5
Xinyu Chen, Jiawei Guo, Yongqi Dou, Xinping Yi, Yongjiang Xiong, Tao Zhao
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Abstract

Purpose: The aim of this study was to investigate the efficacy and safety of three minimally invasive surgical approaches for treating large upper ureteral stones complicated by infection in elderly (> 60 years) patients.

Methods: Clinical data from 95 elderly patients with large upper ureteral stones and infection, treated at our hospital between January 2018 and April 2023, were retrospectively analyzed. The surgical approaches included FURL (flexible ureteroscopic lithotripsy) 33 cases, mPCNL (minimally percutaneous nephrolithotomy) 29 cases, and RLUL (retroperitoneal laparoscopic ureterolithotomy) 33 cases. Surgical time, intraoperative blood loss, postoperative hospital stay, reoperation rate, incidence of postoperative complications, and hospitalization costs were observed and compared among the three groups.

Results: No statistically significant difference was found in stone clearance rates among the three groups (P > 0.05). The FURL group exhibited advantages over the mPCNL and RLUL groups in surgical time, intraoperative blood loss, and postoperative hospital stay (P < 0.05). However, it also had the highest reoperation rate and hospitalization costs (P < 0.05). RLUL demonstrated superiority over the mPCNL and RLUL groups in terms of reoperation rate, incidence of complications, and hospitalization costs (P < 0.05). Notably, mPCNL exhibited the highest complication rate at 37.9% (P < 0.05).

Conclusion: For elderly patients with large upper ureteral stones complicated by infection, FURL, mPCNL, and RLUL represent effective surgical approaches. Further attention is needed regarding the perioperative safety of mPCNL. RLUL, which offers higher safety, efficacy, and cost-effectiveness, can be considered a primary surgical option for these patients.

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老年患者伴有感染的输尿管上段大结石(> 1.5 厘米)的最佳治疗方法:三种微创手术方法的比较分析。
目的:本研究旨在探讨三种微创手术方法治疗老年(大于60岁)患者并发感染的大输尿管上段结石的有效性和安全性:回顾性分析我院2018年1月至2023年4月期间收治的95例老年输尿管上段大结石并发感染患者的临床资料。手术方式包括FURL(柔性输尿管镜碎石术)33例、mPCNL(微创经皮肾镜取石术)29例、RLUL(腹膜后腹腔镜输尿管取石术)33例。观察并比较了三组患者的手术时间、术中失血量、术后住院时间、再次手术率、术后并发症发生率和住院费用:结果:三组结石清除率差异无统计学意义(P>0.05)。在手术时间、术中失血量和术后住院时间方面,FURL 组均优于 mPCNL 组和 RLUL 组(P 结论:FURL 组的手术时间、术中失血量和术后住院时间均优于 mPCNL 组和 RLUL 组:对于合并感染的老年输尿管上段大结石患者,FURL、mPCNL 和 RLUL 都是有效的手术方法。mPCNL 的围手术期安全性需要进一步关注。RLUL具有更高的安全性、有效性和成本效益,可作为这类患者的主要手术选择。
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来源期刊
International Urology and Nephrology
International Urology and Nephrology 医学-泌尿学与肾脏学
CiteScore
3.40
自引率
5.00%
发文量
329
审稿时长
1.7 months
期刊介绍: International Urology and Nephrology publishes original papers on a broad range of topics in urology, nephrology and andrology. The journal integrates papers originating from clinical practice.
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