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9 - The comparison of ureteroscopy and ureterolithotomy for the treatment of large and impacted ureteral stones in the middle and upper part of ureter
Göksel Bayar, Umut Sarıoğulları, Hüseyin Acinikli, Mehmet Taşkıran, Elshad Abdullayev, Muammer Kendirci, Kaya Horasanli, Orhan Tanrıverdi
Objective: We aimed to research the most effective treatment method of the middle and upper ureteral impacted stones of which is 1.5-2 cm diameter size.
Material and Method: Between 2000 and 2013, 75 patients who had impacted stone size of between 1.5-2cm at the middle and upper part of the ureter were examined. Patients had been analysed in terms of their demographical characteristics, stone size, hospitalization time, stone- free and complication rates. For statistical analysis Pearsons chi-square, Mann Whitney-U and student-t tests has applied. The significance level is determined as p<0.05.
Results: Sixty five ureteroscopy and twenty four ureterolithotomy, a total of 87 treatment method had been given to 75 patients. Ureteroscopy had been applied by semi rigid ureteroscope. Eleven of twenty four patients ureterolithotomy were open surgery and 13 were laparoscopic ureterolithotomy. Stone size wasnt greater in the group which has received ureterolithotomy examination compared to group received ureteoscopy examination (503-395 mm3 p=0.172). The hospitalization times was similar for each group (3.4-4.1 days p=0.086). The stone- free rate was 96% for ureterolithotomy group and 46% for ureteroscopy group. Ureterolithotomy has been found more successful then ureteroscopy (p=0.01). Although ureterolithotomy group has only one complications (4%), 1 patient in ureteroscopy group faced with total avulsion and 2 patients were faced ureteral perforation (6.3%).
Conclusion: Due to the failure of semi rigid ureteroscope and the high major possibility of complication even if there is not a flexible ureteroscope option, laparoscopic ureterolithotomy or open surgery can be applied instead of ureteroscopy for the treatment of stones which is seen at the upper and middle part of the ureter.
Keywords: Laparoscopic ureterolithotomy, open ureterolithotomy, ureteroscopy
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