Preoperative hydronephrosis is a predictive factor of ureteral stenosis after flexible ureteroscopy: a propensity scores matching analysis

Objectives

Ureteral stenosis is a serious complication of flexible ureteroscopy. How to predict the possibility of stricture before surgery is an important topic. This research retrospectively studied the influence of preoperative hydronephrosis on ureteral stenosis after flexible ureteroscopy, to explore whether the preoperative hydronephrosis could predict postoperative ureteral stenosis.

Methods

We conducted a retrospective study on patients who received flexible ureteroscopy in our hospital for upper ureteral calculi from January 2015 to June 2018. Patients were followed-up for 36 months after surgery, and intraoperative and postoperative complications were recorded. We divided patients into the mild hydronephrosis group and moderate to severe hydronephrosis group. Preoperative clinical baseline data of the patients were adjusted by propensity matching score analysis. Differences of intraoperative ureteral injury, operative time, postoperative ureteral stricture, and SFR one month after surgery was statistically analyzed. Kaplan–Meier’s method and Log-rank test were used to compare the differences in the cumulative incidence of ureteral stenosis between the two groups. Cox regression was used to compare the hazard ratio of ureteral stenosis between the two groups.

Results

A total of 447 patients with 469 sides surgery were included, including 349 sides in the mild hydronephrosis group and 120 sides in the moderate to severe hydronephrosis group. Twenty-nine patients with 30 sides developed ureteral stenosis. Before and after propensity, the incidence of ureteral stricture matching analysis was 6.4% and 8%, respectively. There were statistical differences in ureteral stricture and injury, but the statistical differences in SFR and operation time were inconsistent. Kaplan–Meier showed a significant difference in the cumulative incidence of ureteral stenosis between the two groups.

Conclusions

Patients with moderate to severe hydronephrosis before surgery were more likely to have an intraoperative ureteral injury and postoperative ureteral stricture after FRUS. Preoperative hydronephrosis is an important predictor of ureteral stricture.

Percutaneous nephrolithotomy vs laparoscopic ureterolithotomy for large upper ureteral stone: A review article

To investigate the best treatment option for large upper ureteral stone, percutaneous nephrolithotomy or laparoscopic ureterolithotomy. We searched three key word of upper ureteral stone, laparoscopic ureterolithotomy, percutaneous nephrolithotomy in PubMed, Scopus and Ebsco. We found approximately twenty suitable articles about this subject since January 1980 until January 2014. All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added. In many studies, it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same, but percutaneous nephrolithotomy has less hospital stay time, duration of surgery and it is more cost effective. Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic ureterolitothomy