ABSTRACT
Objective:To evaluate the best parameter of predicting the operation time and clearance of flexible ureteroscopic lithotripsy through comparing correlations between three stone burden parameters (diameter, area, volume) and the operation time or clearance retrospectively.Methods:Clinical data and CT images of 70 patients who performed flexible ureteroscopic lithotripsy because of single kidney stone in our center from January 2018 to December 2019 were retrospectively reviewed. There were 46 males and 24 females; their age was (47±12) years old. Stones were located on the left side in 28 cases and right side in 42 cases; 32 cases in the renal pelvis , 29 cases in the lower calyx, 6 cases in the middle calyx and 3 cases in the upper calyx. The free software ITK-SNAP 3.6.0 to segment kidney stones in 3D models with the CT image was used. The stone volume was calculated automatically after the segment. The largest section of the stone on the CT coronal plane was selected to measure the maximum length (D) and width (d) of the stone, the maximum diameter of the stone was D, and the stone area was calculated using the formula 0.25πDd. The patients were divided by the operation clearance into total clearance group and partial clearance group. The correlations between three stone burden parameters (volume, diameter, area) and operation time or clearance of the flexible ureteroscopic lithotripsy were compared. Simple linear regression model was also applied to compare three measurement methods. Then other factors which may affect the operation time was evaluated with the stepwise linear regression model, such as stone component and location.Results:The median operation time was 63(50, 84)min. Of 70 cases, 47 cases were in the stone-free group, with stone volume 633(248, 1 087)mm 3, maximum diameter 15(10, 19)mm, and area 82(49, 186)mm 2. 23 cases were in the non stone-free group, with volume 696(408, 1 418)mm 3, maximum diameter 15(12, 20)mm, area 105(73, 201)mm 2. There was no difference between the two groups in volume, maximum diameter and area of stones (all P>0.05). The stone-free rate of the diameter >2 cm group was 55% (6/11), ≤2 cm group was 70% (41/59). There was no significant difference between the two groups. Correlation between stone volume and operation time is the best. The correlation coefficient of stone volume is 0.58, of stone diameter is 0.33, of stone area is 0.34. Coefficients of determination of the stone volume linear regression is the best, too. R square of stone volume is 0.36, of stone diameter is 0.17, of stone area is 0.22. Forward stepwise regression model shows stone volume is the most important parameter which correlate with operation time. None of stone volume, diameter or area has significant correlation with the clearance of stone. Conclusion:Stone volume is the best predictive parameter of the stone burden because it has the best correlation with the operation time of the flexible ureteroscopic lithotripsy of the single kidney stone.
ABSTRACT
Objective:To compare the accuracy of renal calyceal fornix puncture and complication between non-vascular contrast-enhanced ultrasound (NV CEUS) and conventional ultrasound guided in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods:This randomized controlled trial was conducted in nephrolithiasis patients with slight or no hydronephrosis in our hospital from May 2018 to June 2019. The patients were randomized to receive NV CEUS or conventional ultrasound guided PCNL.Inclusion criteria: age 18-70 years old and nephrolithiasis patients with slight or no hydronephrosis. Exclusion criteria: pregnant women, functional solitary kidney, abnormal anatomy or high-risk of intestinal injury, acute urinary tract infection, coagulation dysfunction or taking drugs that affect blood coagulation, heart failure, severe arrhythmia or other high-risk diseases, abnormal renal function (SCR > 1.2-fold upper limit), or severe obesity (BMI>40 kg/m 2). Patients in both groups underwent anterorenal pyelography of renal fistula. Data of the study were recorded: the decrease in hemoglobin, the puncture time, the success rate of one needle puncture, the time of hospital stay, the stone for free, and postoperative renal fistula anterograde pyelography to confirm whether the puncture was performed through the calyces. Results:A total of 48 patients were enrolled, 24 patients in each group, the preoperative parameters were comparable between the two groups(all P>0.05). The puncture accuracy of calyces fornix in experimental group and control group was 87.50%(21/24) and 41.67%(10/24), respectively.The hemoglobin drop was 2.0(0.0, 12.0) and 14.0(7.0, 17.0) g/L, the puncture time was 40.0(28.5, 53.0) and 70.0 (55.5, 84.5) seconds, and the success rate of one needle puncture was 95.83%(23/24) and 75%(18/24). The differences between the two groups were statistically significant (all P<0.05). No blood transfusion, interventional embolization, septic shock and other serious infection complications were found in the two groups. Conclusions:For nephrolithiasis patients with slight or no hydronephrosis, NV CEUS guided can significantly improve the accuracy of calyx vault puncture, shorten the puncture time and reduce bleeding compared with conventional ultrasound guided PCNL.
ABSTRACT
Objective To summarize the management experiences of pancreatic injuries during laparoscopic urologic surgery.Methods From June 2003 to August 2008,395 laparoscopic operations for upper urinary or adrenal diseases were performed.4 cases of pancreatic injuries which all occurred in left side introperiotoneal procedures were identified with the incidence of 1%.2 men and 2women were involved with the mean age of 45.3(range 32~76y).2 injuries occurred during left radical nephrectomy and 2 during left adrenalectomy.All the injuries located at tail of pancreas with transaction injuries in 2 cases,and mild laceration in 2 cases.Only 1 case had received open surgery for pancreatic debridement,another 3 cases had received clamp and endo-GIA occlusion laparoscopically with local styptic powder aspersing and drainage.Absolute diet,gastrointestinal decompression,,transvenous-use of Somatostatin and hyperalimentation were given routinely.Results The mean blood,urine and drainage fluid diastase that were(648?136)U、(1278.6?368.4)U and(1368.5?428.2)U respectively elevated in all 4 cases postoperatively.Only 1 case had high fever and blood WBC after operation.The mean drainage and hospital stay was 14.2 and 24.6 days.No sequelae was found.Conclusion The tail of pancreas is the most predilecting location of pancreatic injury in laparoscopic urological surgery.The key of ensuring a good prognosis is early detection and suitable management.A severe laceration of the main excretory pancreatic duct need a open surgical management,conservative managements are suitable for a small tear and mild contusion of pancreas.