Background: There are three minimally invasive methods for the management of large upper impacted ureteral\nstones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and\nretroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to\nevaluate which one is the best choice for large upper impacted ureteral stones.\nMethods: Between January 2012 and December 2015, at the Department of Urology, Huai�an First People�s\nHospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included.\nThe patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was\nsuccess of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and\npostoperative parameters and complications.\nResults: Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The\nstone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group\nthe stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083\nvs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was\nshorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the\nlongest with MPCNL (all P < 0.05).\nConclusions: MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be\nconsidered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery.
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