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Objective To investigate the safety and efficacy of ureteral access sheath (UAS) with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones.Methods The clinical data on 56 patients with infectious renal stones who received flexible ureteroscopic lithotripsy were retrospectively analyzed.The patients were randomly divided into group A (26 patients) and group B (30 patients).Intrapelvic pressure,stoneclearance rate,surgical duration,formation of steinstrasse,postoperative fever (temperature ＞ 38.5 ℃C),PCT,leukocyte count,length of hospital stay,and hospitalization cost were evaluated.Results Intrapelvic pressure was much lower in group A than in group B;stone clearance rate was 96.2％ for group A and 83.3％ for group B;and surgical duration was (80.1 ± 2.2) min and (105.2 ± 3.5) min,respectively.One patient developed steinstrasse and one had postoperative fever in group A,while six patients developed steinstrasse and 4 had postoperative fever in group B;PCT and leukocyte count was much lower in group A than in group B.There were statistical differences between the two groups (P ＜ 0.05).The length of hospital stay and hospitalization cost were (7.4 ± 0.8)d and (20857.1 ± 389.4) RMB for group A and (8.2±1.3)d and (22008.5±394.3) RMB;but there were no statistical differences between the two groups (P ＞ 0.05).Conclusions Application of ureteral access sheath with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones was safe and effective.It can shorten surgical duration,improve stoneclearance rate and reduce incidence of adverse reactions.This procedure has better value of clinical application.
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Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with diabetes mellitus and non-diabetic patients. Methods A retrospective analysis was performed to look into the clinical data of 2,796 patients undergoing downward F18minimally invasive percutaneous nephrolithotomy during May 2007 to June 2016 under X-ray guidance Among them,582 diabetic patients were assigned as the diatetes group,aged 26-82 years,279 male,303 female, 174 with pelvic stones,255 with multiple calculi,153 with staghorn calculi,fasting blood glucose 5.4~20.3 mmol/L,postprandial and 2 hours blood glucose 9.1~28.9 mmol/L. In the group,the results of preoperative fasting blood glucose,glycosylated hemoglobin,meal 2 hours blood glucose,diabetes mellitus immune and two others,were in line with diabetes diagnosis and typing standard, and the stones were tested by infrared spectrum analyzer for determination of chemical composition(P0.05),but the hospital stay in the diabetic group was significantly longer than that of the control group. In comparison of the stone compositions,therate of uric acid stones in the diabetic group was significantly higher than that of the control group (P < 0.05). Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of renal calculi in patients with diabetes mellitus. Diabetic patients are susceptive to uric acid stones and those patients at the poor control of blood glucose suffer from a higher recurrence of renal stones , which reminds the importance of doctors to educate the patients on the prevention of kidney stones.
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Objective To explore the risk factors ,prevention and treatment of the occurrence of perirenal hematoma after flexible lithotripsy. Methods We retrospectively analyzed the clinical data of 18 patients with symptomatic perirenal hematoma from 1259 who had undergone ureteral flexible lithotripsy in our hospital during the period of April 2007 to April 2016. Of the 18 patients,7 were complicated with diabetes mellitus,11 had urinary tract infection;15 were female,and 3 were male. Results Perirenal hematoma was confirmed by B ultrasound and CT,which situated on the Posterolateral side of the kidney in 8 patients,and on the lower pole and abdominal side in 10. Hematoma depth was 2.6-15.3 cm(average was 5.2 cm). The hematoma?related symptoms gradually disappeared in 11 patients 7 to 14 days after they received conservative treatment. 5 recovered gradually 15 days after undergoing hematoma puncture and drainage ,and 2 recovered 36 days after receiving open surgery for removal of hematoma. Conclusions Female,diabetes,urinary tract infection,bigger stone size,prolonged surgical duration,and infected stones were the risk factors for perinephric hematoma related to ureteroscopic lithotripsy. Full preoperative preparation ,effective anti?infection ,intraoperative improvement of calculus?breaking skills and use of large caliber semirigid through sheath,low pressure perfusion,shorter surgical duration,and staging surgery are effective ways to reduce the occurrence of perirenal hematoma.
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<p><b>OBJECTIVE</b>To define the clinicopathological risk factors of intravesical recurrence of primary transitional cell carcinoma of the ureter after surgical intervention.</p><p><b>METHODS</b>Patients with primary carcinoma of the ureter treated between January 2000 and December 2010 were retrospectively analyzed. The intravesical recurrence-free survival rate was calculated using Kaplan-Meier method. Multivariate analysis was conducted with Cox's regression.</p><p><b>RESULTS</b>A total of 104 patients were enrolled, who were followed up for a median of 46 months (13-89 months). Thirty-nine of the patients showed postoperative intravesical recurrence. Urine exfoliative cytology (P=0.000), number of tumors (P=0.006), tumor grade (P=0.039) and co-existence of bladder tumor (P=0.014) were found to independently influence the postoperative intravesical recurrence. Patients with more risk factors had poorer intravesical recurrence-free survival.</p><p><b>CONCLUSION</b>Urine exfoliative cytology, number of tumors, tumor grade and co-existence of bladder tumor are independent risk factors for postoperative intravesical recurrence of primary transitional cell carcinoma of the ureter. Close follow-up and rigorous treatment are essential for patients with high risk factors.</p>