Retroperitoneal Ureterolithotomy: The Preferred Surgical Method for Elderly Patients with Impacted Upper Ureteral Calculi and Infection

Abstract

Flexible ureteroscopic lithotripsy (FURL), retroperitoneal ureterolithotomy (RLUL), and minimally percutaneous nephrolithotomy (mPCNL) are the three primary minimally invasive techniques for treating upper ureteral calculi with infection. This study sought to find out the best surgical technique for treating older patients with impacted upper ureteral calculi that were infected by examining the safety and effectiveness of three minimally invasive surgical approaches. In this investigation, the clinical data of ninety-five elderly patients treated with FURL (33), mPCNL (29), and RLUL (33), in our hospital between January 2018 and April 2023, with impacted upper ureteral calculi and infection, were retrospectively evaluated. The three groups did not significantly differ in the stone clearance rate (P > 0.05), with the RLUL group having the highest rate at 97%. The FURL group was superior to the mPCNL and RLUL groups in operation time, intraoperative blood loss, and postoperative hospital stay ( P < 0.05 ), but the second operation rate ( 100% ) and hospitalization cost were the highest ( P < 0.05 ). RLUL was superior to the mPCNL and RLUL groups in the rate of secondary operation, the incidence of complications, and the cost of hospitalization ( P < 0.05 ). The complication rate of mPCNL was the highest ( 37.9% ) ( P < 0.05 ).Therefore for older patients with infection-related impacted upper ureteral calculi, FURL and RLUL are both safe and efficient surgical techniques. Further research is required to determine the safety of mPCNL. For the patients listed above, RLUL can be utilized as the preferable surgical technique due to its excellent levels of safety, efficacy, and economy.