Comparison of the efficacy of different surgical approaches for complicated impacted proximal ureteric calculi based on a new scoring standard : a matched-pair analysis

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 underwent URSLwere collected in this retrospective study between January 2015 and April 2021. 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 regards to age, sex, BMI. Peri-operative 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 (53.69 ± 25.07 min vs. 73.46 ± 27.12 min, p < 0.05), 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 (3.68 ± 2.70 d vs. 6.39 ± 3.34 d, p < 0.05). There was significant difference in complication rate between the two groups in regards to Clavien grade I, II, or III complications (20.0% in URSLgroup vs. 8.9% in PCNL group, p=0.32). 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 ureter stone.