Buku Rpul Sd Pdf Downloadl
retroperitoneoscopy is a less invasive and safer approach that minimizes iatrogenic damage to surrounding structures [ 14 ]. the reported success rates of ursl, mpcnl, and rpul have ranged from 87% to 100% [ 15 – 17 ]. two studies reported on the use of rpul to treat upper ureteral stones; both studies included stones <15 mm and the success rates were 100% [ 18, 19 ]. however, this technique was not available at our hospital during the study period. we were able to perform rpul only in patients who were highly suspicious of having a stone in the lower pole of the kidney or in patients with high-risk features of hydronephrosis or a stone near the ureteropelvic junction. rpul is considered a high-risk procedure for ureteric perforation and bladder injury; therefore, we did not perform this procedure in women of childbearing age or in patients with a stone size >15 mm. rpul is associated with a higher morbidity rate and longer hospital stay [ 20 ]. in our study, the mean operation time was 55.7minutes for rpul, which was significantly shorter than the time taken for ursl (111.98minutes) and mpcnl (125.642.1minutes) but similar to the time needed for rpul by fan et al (49.8minutes) and zhu et al (42.6minutes) [ 21, 22 ].
our study included a relatively large number of patients who had stones <15 mm (mean stone diameter, 8.05mm). the success rates for rpul, mpcnl, and ursl in these patients were 100%, 92.6%, and 100%, respectively. these results are similar to those found in previous studies. on the other hand, our study also included patients with a stone larger than 15 mm, which is a high-risk feature for the failure of rpul. the success rate of rpul was only 25% in these patients. this is a relatively high failure rate, and it suggests that rpul is not a good option for large ureteral stones that pass slowly and do not have a complex anatomy. our results are similar to those of fan et al [ 21 ], who reported that the success rate of rpul was 83.3% in patients with stones larger than 15 mm. the failure of rpul in our study was related to the stone size; therefore, a larger sample size may be required to achieve better results. in addition, we did not perform rpul in patients with a stone size >15 mm. no patient who underwent rpul required an additional operation, and the mean hospital stay was only 2.5 days, which was significantly shorter than the mean hospital stay for ursl and mpcnl (4.5 and 6.8 days, respectively). the results of this study are comparable to those of park et al [ 23 ] and zhu et al [ 22 ], who reported that the mean hospital stay for rpul was 3.6 days and 2.8 days, respectively. our study also found that the hospital stay after rpul was significantly shorter than the hospital stay after ursl and mpcnl. in addition, rpul has been reported to have a lower complication rate than mpcnl [ 24 ].
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