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Percutaneous nephrolithotripsy is the first line treatment for complete staghorn calculi, but there are risks such as renal function damage, bleeding, and infection. A case of complete staghorn calculi 8.3 cm×4.5 cm and mean CT value of 1 321 HU was reported. Urine culture suggested proteus mirabilis infection. The patient was given sensitive antibiotics for 3 days, and was treated with one session of natural orifice transluminal endoscopic lithotripsy with intelligent control of renal pelvic pressure. KUB on the first postoperative day showed residual stones of 1.0 cm×0.5 cm. There were no complications.
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Objective@#To evaluate the effectiveness and safety of intelligent pressure control flexible ureteroscope for management of renal stones ≤2 cm.@*Methods@#The clinical data of 267 cases of renal calculi treated with flexible ureteroscope lithotripsy at Department of Urology, Ganzhou People′s Hospital from June 2015 to December 2017 were analyzed retrospectively. There were 129 male and 138 female patients, with a mean age of 51.2 years (ranging from 19 to 76 years). Among them, 145 patients underwent intelligent pressure control flexible ureteroscope (intelligent control group) and 122 patients underwent flexible ureteroscope ordinary (ordinary group). The t test, χ2 test or Fisher exact test were used for statistical analysis. The success rate of stone seeking, the stone free rates, the incidence of complications, the average operation time, the average hospital stay after operation were compared between the two groups.@*Results@#The average mean operative time of the patients with intelligent control group was (26.17 ± 8.64) minutes, significantly shorter than (47.23±18.35) minutes of the ordinary group (t=1.968, P=0.000). The stone free rate of the patients with intelligent control group was 97.2%, it was higher than 86.0% of ordinary group (χ2=0.069, P=0.004). The complication rate of the patients with intelligent control group was 2.7%, which was significantly shorter than 18.0% of the ordinary group (χ2=17.586, P=0.000). However, there was no significant difference between the two groups in the success rate of stone seeking and postoperative hospital stay (P>0.05).@*Conclusion@#Intelligent controlled pressure ureteral flexible ureteroscope has the advantages of short operation time, high stone free rate and less complications in the treatment of renal calculi ≤2 cm compared with flexible ureteroscope ordinary.
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Objective To evaluate the efficacy and safety of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure in the treament of intrarenal and proximal ureteral stones.Methods From November 2014 to December 2016,a total of 372 patients,including 200 males and 172 females,with upper urinary tract calculi were studied.The average age of patients was 48.1 years old.The average size of stone was 5-35mm,mean 15.7mm.There were 272 cases of renal calculi,80 cases of ureteral calculi and 20 cases of renal calculi combined with ureteral calculi.There were 252 cases of single calculi and 127 cases of multiple calculi.There were 237 cases of urinary tract infection and 14 cases of bacteremia.All patients were treated by suctioning fiexible uretemscopy with automatic control of renal pelvic pressure by a patented intelligent system including an irrigation and suctioning platform and a ureteral access sheath with a pressuresensitive tip.Statistical analysis was performed regarding renal pelvic pressure,operative time,stone-free rates,and complications.Results Three hundred and thirty of 372 patients only accepted one surgery to remove the stone.There were 12 cases of upper ureteral calculi were converted to ureteroscope lithotripsy.Seventeen cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis.Seven cases who failed the first surgery due to difficulty in placing the ureteral access sheath but flexible ureteroscopy were successfully performed in these patients after indwelling a D-J stent for 2 weeks.No stone was found in 6 cases,and the soft endoscope of ureter was examined.In all patients,the renal pelvic pressure of the pelvis was controlled within 20 mmHg.The average operative time was 15-180 min(mean 58.9 min).The stone-free rates was 95.55％ (322/337),the incidence of postoperative fever was 2.97％ (10/337),the sepsis rate was 1.19％ (4/337),the incidence of urinary sepsis was 0.89％ (3/337),the incidence of lumbago caused by extravasation was 0.59％ (2/337),and no peripheral viscera injury or death case.There was no statistically significant difference between preoperative and postoperative white and red blood cells (P ＞ 0.05).Conclusions This new type of suctioning flexible ureteroscopy with intelligent pressure-control has the advantages of perfusion attraction,pressure feedback,intelligent control and visualization of intracavity pressure.It could be a new type of operation with high safety,low complication and high stone free rate.
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Objective To explore the therapeutic effect of laparoscopic surgery for complicated ureteral strictures after Holmium laser lithotripsy.Methods There were 67 patients with ureteral stenosis after ureteroscopic lithotripsy or percutaneous nephrolithotomy Holmium laser lithotripsy from January 2009 to September 2017.There were 38 males and 29 females.The average age of patients was 37 years old(rang 21-62 years).47 cases were hospitalized because of osphyalgia,among whom 8 cases had fever.There were 19 cases of upper ureteral calculi postoperative stenosis,18 cases of middle ureteral calculi postoperative stenosis and 30 cases of lower ureteral calculi postoperative stenosis,17 cases of whom had complete atresia.6 patients had received twice Holmium laser lithotripsy.Two patients had received triple Holmium laser lithotripsy.In 67 cases,11 cases had received a ureteral stent placement to dilate the affected ureter.2 cases had received twice ureteral stent placements,two double-J tubes were placed in the two stage surgery.2 cases had received treatment of incision inside the ureteral stricture by ureteroscope,but symptoms recurred after removal of the double-J tube.There were 15 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 27 cases,severe hydronephrosis in 25 cases.The depth of separation of the renal collecting system was (3.85 ± 0.58) cm,preoperative serum creatinine was 115μmol/L on average (range 46-258 μmol/L).The surgery was done by the abdominal pathway or posterior abdominal pathway.52 patients had ureteral stenosis resection plus ureter end anastomosis,15 patients had ureteral bladder replantation.Results All the patients had successful surgery.The operation time was 65-160 min,and the average operation time was 82 min;the intraoperative blood loss was about 20-300 ml,and the average blood loss was about 56 ml;Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic.The stent was removed after 2-3 months and patients were followed up for 5-24 months after removing the double-J tube,with an average of 12 months.The patients with osphyalgia were significantly relieved.The separation of the renal collecting system was reduced to(3.85 ± 0.58)cm,postoperative serum creatinine was 75.8 μmol/L on average (range 47-165 μmol/L).Renal function stop deterioration in 67 patients.Conclusion The operation of laparoscopic ureteral strictures resection plus ureter end anastomosis or ureteral bladder replantation after ureteral strictures due to the use of Holmium laser lithotripsy is the minimally invasive,safe and effective treatment.
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Objective To compare the safety and efficacy of oblique supine position and lithotomy position in suctioning flexible ureteroscopic lithotripsy. Methods 82 patients with upper urinary calculi were divided into two groups. Group 1 included 47 patients who were treated by suctioning flexible ureteroscopy in oblique supine position. Group 2 included 35 patients who were treated in lithotomy position. There was no significant statistical difference in age, gender and complications between the two groups before surgery (P > 0.05). The operative time, stone-free rates at postoperative 30 d, renal pelvic pressure (RPP), postoperative complications (graded by the Clavien system) and length of stay were compared. Results Retrograde Intrarenal Surgery (RIRS) was successful in 73 cases, and 9 cases of patients were done successfully after indwelling DJ tube 2 weeks. Compared with lithotomy position, a significantly greater stone-free rate of 30 d, shorter operative time (P 0.05). Conclusions Suctioning flexible ureteroscopic lithotripsy in the oblique supine position is safe, and more effective than supine lithotomy position.