Objective: To determine an efficient method for treating upper ureteral impacted stones, we compared the outcome of minimally invasive percutaneous nephrolithotomy (MPCNL) with the aid of our patented system (PMPCNL), traditional MPCNL, and transurethral ureteroscopy. PATIENTS AND Methods: From September 2009 to Septmber 2014, 4 hospitals in China had executed this prospective multicenter study. A total of 273 patients with complicated impacted upper ureteral stones above the level of L4 were

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... ndomly divided into 3 groups. Group 1 included 91 patients who were treated with MPCNL with the aid of a patented system. Group 2 included 91 patients who were treated with traditional MPCNL .Group3 included 91 patients who were treated with ureteroscopy. The patients underwent postoperative shock wave lithotripsy, when necessary. The operative time, stone clearance rate, operative complication markers (amount of intraoperative bleeding and postoperative fever rate), and cost of treatment were compared. Results: A significantly shorter operative time, greater rate of stone clearance, lower need for postoperative shock wave lithotripsy, and lower rate of postoperative fever was found in group 1 and group 2 compared to group 3 (p<0.05). However, the cost of treatment and amount of intraoperative bleeding in groups 1 and 1 were significantly greater. PMPCNL group was superior to MPCNL group in terms of operation time, incidence of postoperative fever, and stone-free rate by one surgery. Conclusion: MPCNL with the aid of the patented system could be the first choice in treating complicated impacted upper ureteral stones above the level of L4.