ABSTRACT
Objective To evaluate the efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal and upper ureteral stones . Methods A total of 97 patients with renal and upper ureteral stones were treated with modular flexible ureteroscopy combined with holmium laser lithotripsy in our hospital from October 2012 to February 2016.Under general anesthesia (90 cases) or epidural anesthesia (7 cases), a flexible ureteroscope was used to find renal or ureteral calculus and holmium laser lithotripsy was applied at a maximum energy of 1.2-1.6 J/10 -12 Hz (12-20 W).F6 or F7 double-J stents and catheters were routinely placed postoperatively .B-ultrasonography , KUB or CT were performed to evaluate the stone free rate 4 weeks after operation . Results Two patients suffered ureteral perforation due to stenosis and tortuosity of the ureter , and were given double-J stent placement under rigid ureteroscopy for 2 weeks and then flexible ureteroscopic treatment .Six patients underwent staged operations because of ureteral strictures .The operations were successful in the remaining 89 patients.Except for unsuccessful exploration in 3 cases of lower calyx calculi , the operation time of other 94 patients was 30-190 min (mean, 100 min).The stone detection rate was 96.9%(94/97), and the stone free rate was 88.6% (86/97).The stone free rates were 100.0% (25/25) for upper and middle calyx calculi, 75.0%(9/12) for lower calyx calculi, and 85.1% (23/27) for pelvis and multiple calyx calculi. Ureteral perforation was encountered in 2 cases.No massive hemorrhage occurred .Postoperative high fever was seen in 5 cases, with a body temperature of 38.5-39.3℃, which were cured after anti-infection treatment for 2 -7 d.The patients were discharged from hospital in 2-7 days (mean, 3.3 days) after operation.Review with B-ultrasonography, KUB or CT at 4 weeks after operation found 5 cases of residual stones >4 mm, including 3 cases located in lower calyx and 2 cases in multiple calyx . Conclusion Modular flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe for the treatment of renal calculi .
ABSTRACT
Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser litho-tripsy on the treatment for upper ureteral calculi of solitary kiden. Methods There were 26 cases of upper ureteral calculi of solitary kidney, including 12 cases of left ureter calculi and 14 cases of right ureter calculi. The diameter of the calculi ranged from 0. 6~2. 2 cm, averagely (1. 38 ± 0. 22) cm. F6 double-J tubes were indwelled postoperatively for 4 weeks, and catheters were indwelled postoperatively for one week. Examine with KUB one day after operation to evaluate the effective rate. Results The Ureteral guiding sheath were successfully implanted in 23 cases, 2 cases underwent second lithotripsy after indwelling D-J tubes 2 weeks later, D-J tubes failed to be implanted only in one case, which has changed to percutaneous nephrolithotomy (PCNL) for ureter stricture. The stone free rates was 88. 5%(23/26)after the first ses-sion,and it was 100%(26/26)at the end of the session. The operation time was 15~45 min, meanly (27 ± 3. 2) min. One patient had ureter perforation during the operation, and one patient had severe infection after operation. Conclusion The modular flexible ureteroscopy com-bined with Holmium laser lithotripsy is an effective and safe treatment, especially for upper ureteral calculi of solitary kideny, and it should be considered as the first choice for solitary kidney calculi.
ABSTRACT
Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser lithotripsy for treatment of renal calculi. MethodsA total of 46 patients with renal calculi were treated with modular flexible ureteroscope combined with Ho:YAG lithotripsy in our hospital from December 2009 to May 2011.There were 19 cases in middle and upper calyx,8 cases in lower calyx,15 case in renal pelvic,and 4 cases in multiple calyxes.The calculi diameter ranged from 6mm to 31 mm (average in 15 ± 7.9 mm).Flexible ureteroscope was used to find renal calculus under epidural anesthesia,and Holmium laser lithotripsy was used at a maximum energy of 12 to 20W (0.8 - 1.0 J/15 -20Hz).F5 or F6 double-J tubes and catheters were indwelled routinely postoperatively.-examine with KUB and removethe catheter 2 days after operation.Re-examine with B-ultrasonography or KUB 4 weeks after op-eration to evaluate the stone free rate.Residual stones ≥4 mm were regarded as clinical significance of residual stone fragments. Results 45 operations were successful except one case changed to percutaneous nephrolithotomy (PCNL) because of ureteral stricture.The operation time was 45 -150 min (average in 110.4 ±25.3 min).The patients were discharged from hospital in 2 -5 days(average in 3 days) after operation.The stone detection rate was 95.6％ (44/46),and the stone free rate was 86.9％ (40/46) after one operation. No severe complications such as ureteral perforation or hemorrhea occurred. Conclusions Modular flexible ureteroscope combined with Holmium laser lithotripsy is effective and safe for treatment ofrenal calculi,meanwhile it can decrease the high maintenance costs of integrated flexible ureteroscope.