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Objective:To explore the effects of retroperitoneal laparoscopic ureterolithotomy (RLU) and urethral ureteroscopic lithotripsy (URL) on renal function, oxidative stress, and immunoglobulin levels in patients with upper ureteral calculi.Methods:The clinical data of 78 patients with upper ureteral calculi, who received treatment in Yiwu Central Hospital from June 2017 to April 2020, were collected for this study. The patients were divided into URL group ( n = 38, URL treatment) and RLU group ( n = 40, RLU treatment) according to different surgical methods. Renal function (creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin), oxidative stress (superoxide dismutase, malondialdehyde), immunoglobulin (Ig) (IgA, IgM, IgG), and complications were compared between the two groups. Results:At 1 day after surgery, creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin in the RLU group were (79.59 ± 6.02) μmol/L,(6.93±1.17) mmol/L,(4.78±0.61) μg/L, respectively, which were significantly lower than those in the URL group [(86.98 ± 8.27) μmol/L, (7.62 ± 1.24) mmol/L, (6.03 ± 0.79) μg/L, t = 4.53, 2.53, 7.85, P < 0.001, P = 0.014, P < 0.001). At 1 day after surgery, IgA, IgM, and IgG in the RLU group were (1.94 ± 0.25) g/L, (1.55 ± 0.24) g/L, (6.59 ± 1.25) g/L, respectively, which were significantly lower than those in the URL group [(2.38 ± 0.23) g/L, (1.82 ± 0.27) g/L, (7.89 ± 1.36) g/L, t = 8.08, 4.67, 4.40, P < 0.001, 0.001, 0.001]. At 1 day after surgery, malondialdehyde level was significantly lower in the RLU group than in the URL group [(7.49 ± 1.26) mmol/L vs. (8.93 ± 1.38) mmol/L, t = 4.817, P < 0.001]. At 1 day after surgery, superoxide dismutase level was significantly higher in the RLU group than in the URL group [(72.18 ± 7.55) mg/L vs. (63.49 ± 6.69) mg/L, t = 5.37, P < 0.001). There was no significant difference in the incidence of postoperative complications [15.79% (6/38) vs. 7.50% (3/40), χ2 = 1.31, P = 0.252]. Conclusion:RLU for the treatment of upper ureteral calculi has fewer effects on renal function, oxidative stress, and immunoglobulin level in patients with upper ureteral calculi compared with URL and does not increase the incidence of complications.
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Resumen: Introducción: el desarrollo de técnicas de mínimo acceso en el tratamiento de litiasis urinaria ha modificado el manejo de esta patología en la actualidad; sin embargo, el desafío terapéutico continúa siendo grande en pacientes con cálculos complejos del uréter proximal y pelvis renal, donde una buena opción es la cirugía laparoscópica. Materiales y métodos: fueron tratados mediante cirugía laparoscópica 10 pacientes durante el primer semestre del año 2016, portadores de litiasis piélica compleja y de uréter proximal (> 15 mm); edad: 38 años (±11.66). Localización de los cálculos: 8 en el uréter proximal y 2 en la pelvis renal. Resultados: tiempo operatorio: 65 a 270 minutos; pérdida de sangre media: 31.25 ml (± 6.29), producción del dren en el primer día: 36 a 45 ml. Dolor postoperatorio en el primer día postquirúrgico: 3.5 (EVA) (± 2.22). El resultado cosmético fue muy satisfactorio para todos (media: 9.5 ± 0.05). Tasa libre de litiasis: 100%. Discusión: el manejo de los cálculos ubicados en el uréter proximal, cuando son voluminosos o piélicos complejos, son un desafío debido a su menor tasa libre cálculos ya sea con ureterorrenoscopia o litotripcia extracorpórea; una opción para el tratamiento de este tipo de litiasis es la cirugía laparoscópica (tasa libre de cálculos hasta 100% en una sola sesión) y mejoría de los parámetros como estancia hospitalaria, requerimiento de tratamiento analgésico adicional, recuperación y resultados cosméticos. Conclusiones: los cálculos de volumen considerable o situados en una parte del aparato urinario de difícil acceso se tratan con éxito a través del abordaje laparoscópico, que es una opción ideal que sustituye el abordaje abierto y métodos endourológicos en casos seleccionados. Palabras claves: ureterolitotomía laparoscópica, cálculo ureteral, cálculo piélico, ureterorrenoscopia, litotripcia extracorpórea
Introduction: The development of minimal access techniques in the treatment of urolithiasis has changed the management of this condition today; however the therapeutic challenge remains in patients with complex stones in proximal ureter and renal pelvis in which laparoscopic surgery is a good option. Materials and Methods: 10 patients were treated during the first half of 2016, whith diagnosis of complex pelvic lithiasis and proximal ureteral stones (> 15 mm); laparoscopic surgery was indicated. The mean age was 38 years (± 11.66). The location of these lithiasis was 8 proximal ureter and 2 in the renal pelvis. Results: Operative time ranged from 65 minutes to 270 minutes; the mean blood loss was 31.25 cc (± 6.29), drain production on the first day was between 36 ml - 45 ml. Postoperative pain on the first day after surgery was 3.5 (VAS) (± 2.22). The cosmetic result was very satisfactory for all, with an average of 9.5 (± 0.05). stone-free rate was 100%. Discussion: The management of bulky proximal ureteral stones or complex pyelic stones are a challenge because of its low stone-free rate either with ureterorenoscopy or external shock wave lithotripsy; an option for treating this type of stones is laparoscopic surgery, with a stone-free rate up to 100% in a single session and improving parameters such as hospital stay, requirement for additional analgesic treatment, early recovery, and cosmetic results. Conclusions: In complex situations ureteral or pyelic stones are successfully treated through laparoscopic approach, being an ideal choice to replace the open approach and endoruologic methods in selected cases. Key words: laparoscopic ureterolithotomy, ureteral stones, pyelic stones, ureterorenoscopy, shock wave lithotripsy.
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Humans , Nephrolithiasis , Lithotripsy , UrolithiasisABSTRACT
Objective To evaluate the effect of the percutaneous nephrolithotomy ( PCNL) in the manage-ment of complicated upper ureteric calculi , compared with retroperitoneal laparoscopic ureterolithotomy ( RLU ) . Methods Seventy-one cases with complicated upper ureteric calculi were retrospectively investigated ( PCNL group 23 cases,RLU group 29 cases).Clinical data including operation time ,stone free rate and the surgical complications were statistically analyzed .Results All the operations were successful in all 52 cases.Compared with the RLU group,the PCNL group had a significant shorter operation time [(45.12 ±11.56)min vs (82.03 ±12.45)min,t=10.13,P<0.01],and significant difference were detected .A week after the operation,the PCNL group showed a stone free rate of 95.6%(22/23) while the RLU group 100.0%(29/29),and no significant difference were detec-ted.No significant complications ,such as intraoperative or postoperative bleeding and damage to surrounding organs , were detected.The patients were followed up for 6 to 12 months(mean,9 months),and no recurrent stones or ureteral stricture were developed during the period .Conclusion Both PCNL and RLU are safe and effective for complicated upper ureteral calculi.The appropriate method depends on the patients′specific conditions,the unit equipments and the experience of operator .
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ObjectiveTo evaluate the treatment of lower ureteral calculi.Methods Clinical data of 300 cases of lower ureteral calculi were retrospectively analyzed.Among the 300 patients with lower ureteral calculi,171 patients were treated with extracorporeal shock wave lithotripsy (ESWL),95 patients were treated with ureteroscopic lithotripsy (URL),34 patients were treated with laparoscopic ureterolithotomy.ResultsThe clearances of the calculus was 91.81％ with the treatment of ESWL,86.32％ with the treatment of URL and 100％ with the treatment of laparoscopic ureterolithotomy after one month of the treatments.ConclusionESWL is the preferred methods for the treatment of lower ureteral stones.But when the stones≥ 1 cm,URL is superior to ESWL in efficacy; Laparoscopic ureterolithotomy is effective for the treatment of lower ureteral stones which combined with ureteral stricture or ureteral polyps,and with serious incarceration,granulation tissue wrapped around the stone.
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Objective To compare the therapeutic effects of minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneal laparoscopic ureterolithotomy(RLUL) in the management of impacted upper ureteral calculi.Methods A total of 72 patients with unilateral impacted upper ureteral calculi were treated with MPCNL(n=45) or RLUL(n=27).The operation time,clearance rate of the stone,and the incidence of postoperative hyperpyrexia were statistically analyzed.Results All the operations were completed.As compared to the RLUL group,the MPCNL group had a significant shorter operation time [(43?9) minutes vs(69?17) minutes,t=-11.564,P=0.000].On the day after the operation,both the groups showed a stone clearance rate of 100%.No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [13.3%(6/45) vs 11.1%(3/27),?2=0.000,P=1.000).The patients were followed up for 1 to 24 months(mean,8 months),none of them developed ureteral stricture or recurrent stones during the period.Conclusion Both MPCNL and RLUL are safe,effective,and feasible for impacted upper ureteral calculi.
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To compare the efficacy and morbidity of laparoscopic ureterolithotomy and open ureterolithotomy via the posterior lumbar approach. Meterials and Methods: A retrospective study was performed by reviewing patient records. Ten patients in the laparoscopic ureterolithotomy group were compared with 15 patients in the open ureterolithotomy via lumbotomy incision group. Twelve patients who had flank ureterolithotomy comprised a control group. Details of age, sex, size and site of the stone, haematocrit, blood urea nitrogen, serum creatinine, degree of hydronephrosis of the affected kidney, contralateral renal function, operative time, operative complication, the amount of postoperative analgesics and length of hospital stay were all compared. Statistical analysis was carried out by the Chi- square test, Anova and LSD multiple comparisons. Results: The preoperative status of the three groups were similar. When the ureterolithotomy via lumbotomy group was compared with the control group (flank ureterolithotomy) the results were similar except that ureterolithotomy via lumbotomy required less analgesics postoperatively (mean 50 mg vs 104, p < 0.001). Ureterolithotomy via lumbotomy patients required the same analgesics as laparoscopic ureterolithotomy. However, laparoscopic ureterolithotomy had a longer operating time (mean 181.5 min vs 88, p < 0.001) and longer period of urine leak postoperatively (mean 6.6 days vs 2.4, p < 0.003) when compared with ureterolithotomy via lumbotomy. Conclusion: Ureterolithotomy via lumbotomy offers similar low discomfort postoperatively compared with laparoscopic ureterolithotomy but had a shorter operating time and less complications.
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Laparoscopic ureterolithotomy has been attempted in the management of the large, long-standing, impacted ureter stone. However it was not commonly used because of difficulties in technique. So we report 2 cases of laparoscopic ureterolithotomy using the gasless technique. We performed the laparoscopic ureterolithotomy in two patients with ureter stones by transperitoneal approach. We used the laparolift system which was connected by laparofan retractor. The abdominal wall was elevated effectively, and the ureters were exposed with ease. The stone was successfully removed in all two cases. The operative time was 120 and 140 miniutes respectively. There was no intraoperative or postoperative complication including urinary leak in all cases. Postoperative pain was minimal. This gasless technique is convenient and safe because an operator can use the conventional surgical instruments and avoid the complications directly associated with pneumoperitoneum.