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Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.
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【Objective】 To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter. 【Methods】 A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group (n=45) and ordinary group (n=40). The operation time, complications, infection indexes 2 h after operation, adverse reactions, treatment efficacy and stone-clearance rate were compared between the two groups. 【Results】 The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups. The negative pressure group had significantly shorter operation time than the ordinary group [(43.3±4.9) min vs. (66.2±5.8) min, P0.05). The increase of infection indexes (procalcitonin and leukocyte) 2 h after operation were significantly lower in the negative pressure group than in the ordinary group (P<0.05). The efficacy in the negative pressure group was 91.11% (41/45) and the stone-clearance rate was 95.56% (43/45), which were significantly better than those in the ordinary group (72.50% (29/40) and 80% (32/40), respectively. The total incidence of adverse reactions such as renal colic, gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group (P<0.05). 【Conclusions】 Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective, as the circulation perfusion keeps the operation field clear, reduces the operation time and improves the stone-clearance rate, while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.
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【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.
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Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.
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Humans , Salivary Gland Calculi/surgery , Constriction, Pathologic , Endoscopy , Salivary Ducts/surgery , Lithotripsy , Treatment OutcomeABSTRACT
Objective:To explore optimum surgical treatment of ureteral strictures after ureteroscopic holmium laser lithotripsy.Methods:The clinical data of 113 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy from December 2014 to December 2019 were analyzed retrospectively. Of all the patients, there were 73 males and 40 females(aged from 31 to 68) with the mean age of 49 years. The mean length of ureteral stricture was 15mm (from 5mm to 25mm). The mean time since the last holmium laser lithotripsy was 6 months (from 3months to 10 months). According to the different treatment of stenosis, 113 patients were divided into endourological treatment group (34 patients) and reconstruction group(79 patients). According to the different surgical methods, endourological treatment group was divided into ureteral balloon dilatation (18 patients) and ureterotomy (16 patients). Reconstruction group was divided into laparoscopic surgery and open surgery, whose were ureteral stenosis resection and anastomosis. Patients were followed up closely postoperatively. Therapeutic success was defined as disappeared hydronephrosis, and unobstructed anastomosis. Success rate, operation time, postoperative changes of hemoglobin, hospital stay and the incidence of postoperative complications were measured.Results:The follow-up time ranged from 5 months to 53 months, with a median time of 18 months. There was no significant difference in age, sex, BMI, location of ureteral stricture, side of stricture and degree of hydronephrosis between endourological treatment group and reconstruction group( P>0.05). The length of ureteral stricture in reconstruction group was significantly longer than that in endourological treatment group (10.3±4.2 mm vs. 17.2±7.8mm, P<0.001). Although the operation time, postoperative changes of hemoglobin, hospital stay and the incidence of postoperative complications were lower in the endourological treatment group compared to reconstruction group ( P<0.001), the overall success rate of the reconstruction operation was significantly higher than that in endourological treatment group (96.2% vs. 61.8%, P<0.001). Furthermore, there was no significant difference in the success rate between laparoscopic surgery group and open surgery group (95.3% vs.97.2%, P<0.05), and there was no significant difference between the balloon dilatation group and the stenosis internal ureterotomy group (66.7% vs.56.3%, P<0.05).113 cases were followed up for an average of 18 (5-53) months. Conclusions:For the treatment of ureteral stricture after ureteroscopic holmium laser lithotripsy, the success rate of reconstruction group (laparoscopic surgery and open surgery)was significantly higher than that of endourological surgery (balloon dilatation and internal ureterotomy). Reconstruction surgery is the optimum surgical treatment to treat ureteral stricture after ureteroscopic holmium laser lithotripsy.
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Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9％,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6％ (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P ＜ 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P ＜ 0.05) and position (x2 =44.949,P ＜ 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective: To investigate the application effect of balloon dilatation and percutaneous nephrolithotomy (PCNL) combined with pneumatic and ultrasound lithotripsy on the clinical treatment of unilateral kidney stones. Methods: Ninety-four patients with unilateral kidney stones who accepted PCNL in the Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from June 2017 to July 2019, were retrospectively analyzed and divided into group A and group B. Among them, 68 patients (group A) were subjected to balloon dilatation combined with pneumatic and ultrasound lithotripsy, while 26 patients (group B) underwent fascia dilatation combined with holmium laser lithotripsy. The clinical effects of two kinds of lithotripsy on the treatment of unilateral kidney stones were compared. Results: The operation time was shorter in group A than that in group B [(107.82±10.87) min vs (115.41±10.68) min, P=0.003]. The increase rate of postoperative white blood cell (WBC) was lower in group A than that in group B (4.41% vs 23.08%, P=0.018). The fever ( ≥ 38.5 ℃ ) rate was lower in group A than that in group B (4.41% vs 23.08%, P=0.018). There were no significant differences in hemoglobin reduction, WBC count, hospital stay, stone-free rate, blood transfusion rate and perforation rate of collection system between the two groups (all P>0.05). Conclusion: Balloon dilatation combined with pneumatic and ultrasound lithotripsy in treatment of unilateral renal stones by PCNL can shorten the operation time, and reduce the increase rate of postoperative WBC and fever rate, which is worthy of being promoted in the clinical treatment of patients with unilateral kidney stones.
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Objective To investigate the efficacy of ureteroscopic pneumatic lithotripsy and percutaneous renal holmium laser lithotripsy in the treatment of upper ureteral calculi. Methods A total of 132 patients with upper ureteral calculi admitted to our hospital from December 2016 to December 2017 were randomly divided into observation group and control group, 66 cases in each group. The control group underwent ureteroscopic pneumatic lithotripsy, and the observation group used percutaneous nephrolithotomy holmium laser lithotripsy. The clinical efficacy, surgical index and complication rate between two groups were compared. Results The clinical efficacy of the observation group (90. 91％) was higher than that of the control group(75. 76％),and the difference was statistically significant(P ＜ 0. 05). The operation time of the observation group was (27. 53 ± 3. 97) minutes,which was shorter than (42. 59 ± 4. 34) minutes of the control group,and the postoperative blood loss was (18. 59 ± 5. 21) mL,which was less than (31. 68 ± 4. 72) mL of the control group, the difference was statistically significant(P ＜ 0. 05). There was no significant difference in postoperative hospital stay between observation group[(5. 31 ± 1. 62) days]and control group[(5. 28 ± 1. 48) days](P ＞ 0. 05). There was no significant difference in the incidence of complications between two groups (P ＞ 0. 05). Conclusion Percutaneous nephrolithotomy with holmium laser lithotripsy is more effective than pneumatic lithotripsy in the treatment of upper ureteral calculi. It can shorten the operation time, reduce the amount of bleeding, and has higher safety.
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INTRODUCTION@#This study examined the efficacy and safety of cholangiopancreatoscopy via the SpyGlass™ system in routine clinical practice.@*METHODS@#The clinical data of endoscopic retrograde cholangiopancreatography (ERCP) performed in a regional hospital from January 2013 to November 2016 was retrieved from an electronic database and reviewed. All patients who had undergone SpyGlass cholangiopancreatoscopy were enrolled. Patient demographics, procedure indication, technical success rates, clinical success rates and complication rates were analysed. A subanalysis of clinical outcomes was performed comparing the SpyGlass legacy (fibreoptic) and digital systems.@*RESULTS@#Out of 2,050 ERCP procedures performed, 47 patients underwent 50 cholangiopancreatoscopy procedures. Clinical indications were difficult common bile duct (CBD) stones (59.6%, n = 28), indeterminate CBD stricture (36.2%, n = 17), indeterminate pancreatic duct stricture (2.1%, n = 1) and proximally migrated CBD stent (2.1%, n = 1). Complete stone extraction was achieved in 26 (92.9%) out of 28 patients. Among patients with strictures, a correct diagnosis of malignancy based on image visualisation was achieved in all 11 cases. The sensitivity and specificity for SpyBite™ biopsies were 81.8% (95% confidence interval [CI] 48.2%-97.7%) and 100.0% (95% CI 15.8%-100.0%), respectively. The proximally migrated CBD stent was successfully extracted. Complications included pancreatitis (2.1%, n = 1), suspected sealed perforation after laser lithotripsy treated conservatively (2.1%, n = 1) and cholangitis (10.6%, n = 5). There was no difference in clinical outcomes between the SpyGlass legacy (n = 20) and digital (n = 30) systems.@*CONCLUSION@#SpyGlass cholangiopancreatoscopy is a safe and effective tool in routine clinical practice.
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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 explore the clinical effect of the transurethral ureteroscopic holmiumlaser lithotripsy in the treatment of ureteral calculi.Methods This study conducted a retrospective analysis of 205 patients with ureteral calculi from September 2015 to June 2017 in the affiliated hospital of Panzhihua university.According to the surgical method,all the patients were divided into control group (102 cases) who were treated with conventional pneumatic lithotripsy and observation group(103cases) who received transurethral ureteroscopic holmiumlaser lithotripsy.The surgical efficacy,renal function indexes and surgical indexes of the two groups were compared and analyzed respectively.Results The total effective rate of observation group was 97.06％,the control group was 85.00％,the difference between two groups was significantly(P ＜ 0.05).There was no significant difference in Cr and BUN level before surgery between two groups (P ＞ 0.05);after treatment,the Cr and BUN levels of two groups were improved significantly (P ＜ 0.05);while the renal function improved index of observation group was significantly better than that of control group,the difference was significant(P ＜ 0.05).The intraoperative blood loss,operative time and postoperative hospital stay of the observation group were significantly lower than those of control group (P ＜ 0.05).Conclusion The transurethral ureteroscopic holmiumlaser lithotripsy and normal air pressure ballistic were both well treatment for ureteral calculi,but patients with the holmium laser lithotripsy have better renal function indexes and operation index.
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<p><b>OBJECTIVE</b>To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative analgesia of ureteroscopic holmium laser lithotripsy.</p><p><b>METHODS</b>One hundred and twenty adult patients, American Association of Anesthesiologists (ASA) Class Ⅰ or Ⅱ, scheduled to ureteroscopic holmium laser lithotripsy, were randomly assigned into an observation group and a control group, 60 cases in each one. The patients in the observation group were treated with TEAS for postoperative analgesia. TEAS was implemented at bilateral Shenshu (BL 23) and Yinlingquan (SP 9) at the time of back ward and postoperative 4 h, 8 h, 12 h. TEAS at 7:00, 11:00 and 15:00 at the above acupoints were used on the second and third days; while placebo (twice a day, 100 mg a time) was used. Tramadol hydrochloride tablets for postoperative analgesia were applied in the contnol group, twice a day, 100 mg a time, and electrode sheets without stimulation were put on Shenshu (BL 23) and Yinlingquan (SP 9). When analgesia was insufficient with the score of visual analogue scale (VAS)≥3, the patients were treated with tramadol tablets for remedy analgesia. The VAS score, the concentrations of serotonin (5-HT) and substance P (SP) in 3 mL venous blood at the time of back ward (T), postoperative 4 h (T), 12 h (T), 24 h (T), and 48 h (T) were detected respectively. The total amount of medication for remedy analgesia and the incidence of adverse reactions, such as nausea and vomiting within postoperative 48 h were compared between the two groups.</p><p><b>RESULTS</b>The VAS scores at T through T were lower than those at T in the two groups (all <0.05). Compared with the control group, the VAS scores at T through T in the observation group were lower (all <0.05). The total dose of remedy analgesic medicine within 48 h after operation in the observation group was lower than that in the control group (<0.05). Compared with the control group, the concentrations of 5-HT at T, T, T and SP at T through T were lower (all <0.05). The numbers of constipation, nausea and vomiting in the observation group were less than those in the control group (both <0.05).</p><p><b>CONCLUSION</b>TEAS can relieve the pain and reduce the total amount of analgesic medicine, the levels of substance causing pain and the incidence of adverse reactions after ureteroscopic holmium laser lithotripsy.</p>
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Objective To compare the efficacy of simultaneous minimally invasive surgery and staged minimally invasive surgery in the treatment of benign prostatic hyperplasia (BPH) with lower ureteral junction.Methods From August 2016 to August 2017,76 cases of BPH complicated with lower ureteral junction in Lanxi People's Hospital were selected.According to random number table method,the patients were randomly divided into control group and observation group.The control group received the stage of minimally invasive treatment,the observation group was treated with minimally invasive surgery.The incidence of complications 7d after operation was observed.Before operation and 3 months after operation,the prostate symptom score (IPSS),quality of life score (QOL),residual urine volume (RU),maximum urinary flow rate (MFR) were observed in the two groups.The patients' satisfaction with the treatment was investigated in the two groups.Results The amount of blood loss,total operation time,hospitalization time of the observation group and control group were (101.29 ± 10.01) mL vs.(187.62 ± 11.69)mL,(140.12 ±9.81)min vs.(163.98 ± 10.07) min,(8.12 ±0.73) d vs.(13.49 ± 1.21) d,the differences were statistically significant (t =34.579,10.462,23.425,all P ＜ 0.05).Before treatment,the MFR,RU,IPSS and QOL between the two groups had no statistically significant differences (all P ＞ 0.05).Mter treatment,the MFR,RU,IPSS and QOL of the control group and observation group were (19.04 ± 2.17) mL/s vs.(18.87 ± 2.04) mL/s,(30.67 ± 8.19) mL vs.(29.51 ± 8.06) mL,(8.47 ± 1.06) points vs.(8.53 ± 1.02) points,(2.69 ± 0.68) points vs.(2.58 ± 0.61) points,the MFR,RU,IPSS and QOL were significantly improved (t =27.971 and 28.809,74.327 and 74.941,33.440 and 33.670,12.122 and 14.589,all P ＜0.05).After treatment,there were no statistically significant differences in the above indicators between the two groups (t =0.352,0.622,0.251,0.742,all P ＞ 0.05).Postoperative 7 days,the incidence rate of complications of the observation group was 31.58％ (12/38),which of the control group was 21.05％ (8/38),there was no statistically significant difference between the two groups (x2 =1.086,P ＞ 0.05).The satisfaction rate of the observation group was 81.58％ (31/38),the total satisfaction rate was 97.37％ (37/38).The satisfaction rate of the control group was 47.37％ (18/38),and the total satisfaction rate was 76.32％ (29/38).The satisfaction of the observation group was better than that of the control group(Z =-3.290,P ＜ 0.05).Conclusion The curative effect of minimally invasive surgery in the treatment of BPH with middle and lower ureteral calculi is exact,and can reduce the amount of bleeding,shorten operation time and total hospitalization time,faster postoperative recovery in patients with higher satisfaction,it is worthy of clinical promotion.
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Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy.Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively.The patients included 15 men and 11 women,with an average age of 39.5 years (range 24-71 years).The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months).There were 12 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 11 cases,severe hydronephrosis in 3 cases.Preoperative serum creatinine was 102.0 μ mol/L on average (range 53.3-201.4 μmol/L),and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm).The upper ureteral strictures in 6 cases,the middle strictures in 13 cases,and the lower strictures in 7 cases.Results All the operations were completed successfully without conversion to open and no intraoperative death.The average operation time was 121.4 min(range 90-155 min);the estimated blood loss was 92.3 ml (range 30-200 ml);the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d);the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J;the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively;the mean time of double J withdrawal was 76.3 d(range 61-86 d).Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration.Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later.After a period of 11 to 22 months of follow-up,no patient had ureteric re-stenosis.Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopyassisted technique could accurately locate and cure the ureteral strictures.It might be safe and effective with short operation time,less injury and quick recovery.
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Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy.Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively.The patients included 15 men and 11 women,with an average age of 39.5 years (range 24-71 years).The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months).There were 12 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 11 cases,severe hydronephrosis in 3 cases.Preoperative serum creatinine was 102.0 μ mol/L on average (range 53.3-201.4 μmol/L),and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm).The upper ureteral strictures in 6 cases,the middle strictures in 13 cases,and the lower strictures in 7 cases.Results All the operations were completed successfully without conversion to open and no intraoperative death.The average operation time was 121.4 min(range 90-155 min);the estimated blood loss was 92.3 ml (range 30-200 ml);the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d);the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J;the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively;the mean time of double J withdrawal was 76.3 d(range 61-86 d).Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration.Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later.After a period of 11 to 22 months of follow-up,no patient had ureteric re-stenosis.Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopyassisted technique could accurately locate and cure the ureteral strictures.It might be safe and effective with short operation time,less injury and quick recovery.
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Objective To compare of flexible ureteroscope holmium laser lithotripsy and percutaneous nephrolithotomy in treating renal stones of ≤2cm.Methods In this retrospective study,we compared 120 patients of renal pelvic stones of ≤2cm size treated with FURS(n=62)or PCNL(n=58).Factors such as operation time,hospitalization time,stone-free rate(SFR),drop in haemoglobin level,and complications were analyzed.Results The stone burden of the FURS group and PCNL group was(1.4±0.2)cm and(1.6±0.3)cm respectively.In FURS group,The operation time was(28±12)min with postoperatlve fever in 3 cases;he hospitalization time was(3.7±1.8)days.The decrease of hemoglobin was(0.18±0.06)g/L.No major complication was recorded.The SFR was 85.5%(53/62)one week postoperatively and 95.2%(59/62)one month postoperatively.In PCNL group,the operation time was (42±15)min with postoperative fever in 2 cases and bleeding in 2 case.The hospitalization time was 6.8±1.5 days.The decrease of hemoglobin was(14.30±3.50)g/L.The SFR was 91.4%(53/58)one week postoperatively and 96.6%(56/58)one month postoperatively.Conclusion For renal stones≤2cm,FURS has the advantages of shortening operation time,reducing blood transfusion requirements,decreasing postoperative complications with a farely SFR compared with PCNL.FURS is a good alternative.
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Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.
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ABSTRACT Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS) for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD) to classify Glomerular Filtration Rate (GFR) in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675). Significant renal function deterioration occurred in 8 cases (4.9%) and significant renal function amelioration occurred in 23 cases (14.1%). In univariate analysis, multiple procedures (p=0.023; HR: 5.4) and preoperative CKD (p=0.011; HR: 6.8) were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Kidney Calculi/therapy , Kidney/physiopathology , Lithotripsy, Laser/methods , Ureteroscopy/methods , Glomerular Filtration Rate , Kidney Calculi/physiopathology , Lithotripsy, Laser/adverse effects , Multivariate Analysis , Perioperative Period , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Retrospective Studies , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/physiopathology , Severity of Illness Index , Treatment Outcome , Ureteroscopy/adverse effectsABSTRACT
Retrograde intrarenal surgery (RIRS) is being performed for the surgical management of upper urinary tract pathology. With the development of surgical instruments with improved deflection mechanisms, visuality, and durability, the role of RIRS has expanded to the treatment of urinary calculi located in the upper urinary tract, which compensates for the shortcomings of shock wave lithotripsy and percutaneous nephrolithotomy. RIRS can be considered a conservative treatment of upper urinary tract urothelial cancer (UTUC) or for postoperative surveillance after radical treatment of UTUC under an intensive surveillance program. RIRS has a steep learning curve and various surgical techniques can be used. The choice of instruments during RIRS should be based on increased surgical efficiency, decreased complications, and improved cost-benefit ratio.