Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population

ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.

摘要
目的：本研究旨在对比年龄＞65岁的老年患者中，顺行输尿管镜术（anterograde Ureterorenoscopy, URS）与逆行输尿管镜术治疗嵌顿性上输尿管结石的成功率及并发症发生率。
材料与方法：前瞻性收集2014年1月至2018年9月期间，146例年龄＞65岁、因直径＞10mm的上输尿管嵌顿性结石接受顺行URS（n=68，取仰卧位）或逆行URS（n=78）治疗的患者临床资料。对比两组的手术成功率、并发症发生率、手术时长、住院时长及辅助操作情况。
结果：顺行URS组与逆行URS组的人口学特征及结石相关基线特征无显著差异。顺行URS组的手术成功率显著高于逆行URS组（97.1% vs. 78.2%，p=0.0007）。两组并发症发生率无显著差异（p=0.86），每组均有3例出现Clavien Ⅰ级和Ⅱ级并发症。顺行URS组的平均血红蛋白下降量为0.5g/dL，未出现患者需输血的情况。迷你经皮肾镜取石术（mini-PNL）组平均手术时长为41.2±12.5分钟，逆行输尿管软镜碎石术（RIRS）组为59.6±15.1分钟，组间差异具有统计学意义（p=0.02）。两组患者的中位住院时长均为1天。
结论：与逆行URS相比，仰卧位顺行URS可获得更高的手术成功率，且并发症发生率无显著差异。基于上述结果，顺行URS可作为老年人群嵌顿性上输尿管结石的主要治疗方案之一。