Comparative study of minimally invasive endoscopic surgery and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral calculi in pilots

Objective　To observe and compare the therapeutic effect of extracorporeal shock wave lithotripsy (ESWL) and minimally invasive endoscopic surgery (URL/PCNL) for proximal urinary calculi in pilots. Methods　A retrospective analysis was conducted for the clinical data of 115 pilots who had received ESWL, URL and PCNL for the treatment of proximal urinary tract calculi from Sep, 2005 to Sep, 2012. The patients were divided into two groups according to the way of treatment: ESWL group (n=83) and URL/PCNL group (n=32). In ESWL group, the patients received ESWL for a maximum of 3 times. In URL/PCNL group, the patients received URS or PCNL after ESWL for 3 times without lithecbole. Results　All the patients were male and the mean age was 36.1±9.1 years. The average diameter of the stones was 0.68±0.22cm in ESWL group and 0.78±0.25cm in URL/PCNL group. There was no significant difference in stone diameter between the two groups (P=0.526). The rate of qualification for flying was 68.7% in ESWL group and 81.3% in URL/PCNL group (URL 80.0%, PCNL 100%), showing a significant difference (P=0.002). In ESWL group, the rate of qualification for flying of pilots harboring renal and proximal ureteral stone, middle ureteral stone and distal ureteral stone was 64.3%, 88.9% and 33.3% respectively, with a significant difference (P=0.023). The rate of flying qualification of pilots harboring proximal ureteral stone, middle ureteral stone and distal ureteral stone was 71.4%, 86.7% and 87.5% respectively after URL, and there was no significant difference (P=0.174). Among the five patients who received URL but did not achieve satisfactory effect, two had stones retreated to the renal pelvis during the operation, and in two patients distal ureter was too narrow to allow passage of ureteroscope, and the ureteroscope was enveloped by inflammatory polyp in one patient. Conclusion　URL/PCNL maybe more effective than ESWL in the treatment of proximal urinary calculus in pilots, and it may enable them to fly again. DOI: 10.11855/j.issn.0577-7402.2013.12.14