Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi

This study aimed to investigate the efficacy, safety and cost of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) for large proximal ureteral calculi. We retrospectively reviewed the outcomes of 205 subjects with ureteral stones size ≥ 1 cm from January 2011 to December 2017. We divided URSL into two groups including URSL + S with Stone Cone and URSL without Stone Cone. Ninety subjects were treated with URSL, fifty subjects were treated with URSL + S and sixty-five subjects were treated with PCNL. The success rate was 73.3%, 96.0% and 96.6% in URSL, URSL+ S and PCNL groups, respectively. The treatment time in PCNL group (77.3 ± 19.1 minutes) was longer than URSL group (42.0 ± 16.6 minutes) and URSL+S group (55.6± 20.3 minutes), and the hospital stay was longer in PCNL (9.5 ± 1.6 days) group than in URSL group (2.4 ± 4.8 days) and URSL + S group (2.0 ± 2.4 days). The cost-effectiveness ratio was 124.6, 159.1 and 135.3 in URSL, URSL + S and PCNL groups, respectively. In conclusion, Stone Cone could increase treatment success rate but incur higher cost. URSL is considered as the best cost-effective option, and the patients without medical insurance tend to choose PCNL because of high success rate of treatment.