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Objective:To investigate the occurrence of ureteral stricture in patients with ureteral calculi after pneumatic ballistic lithotripsy and its influence on the prognosis of patients.Methods:Using retrospective study method, 42 patients with ureteral calculi who underwent pneumatic ballistic lithotripsy in the Eighth Hospital of Wuhan from August 2018 to August 2020 and developed ureteral stricture were included in the stricture group, 60 patients with ureteral calculi who received the same surgical treatment in the Eighth Hospital of Wuhan without postoperative ureteral stricture were regarded as the non-stricture group. The general data, recurrence at 6 months and 1 year after operation and quality of life score at 1 year after operation were compared between the two groups. The measurement data were expressed by mean ±standard deviation ( ± s), independent sample t-test was used for inter-group comparison, and Chi-square test was used for inter-group comparison of counting data. Univariate and multivariate Logistic regression analysis were used to evaluate the risk factors of ureteral stricture in patients with ureteral calculi after pneumatic ballistic lithotripsy, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the influencing factors on postoperative ureteral stricture. Results:The results of univariate analysis showed that the proportion of patients with disease course ≥ 3 months, maximum diameter of stones > 2 cm, multiple stones, incarcerated stones and inflammatory mucosa-wrapped stones in the stricture group were significantly higher than those in the non-stricture group ( P<0.05). Multivariate Logistic regression analysis showed that the course of disease ≥ 3 months, the maximum diameter of stones > 2 cm, multiple stones, incarcerated stones and inflammatory mucosa-wrapped stones were all risk factors for postoperative ureteral stricture ( P<0.05). The area under the ROC curve of each factor predicting postoperative ureteral stricture were 0.685 (95% CI: 0.602-0.768), 0.743 (95% CI: 0.685-0.801), 0.812 (95% CI: 0.749-0.875), 0.853 (95% CI: 0.801-0.905), 0.726 (95% CI: 0.673-0.779), all have high predictive value ( P<0.001). The recurrence rate at 6 months after operation in the stricture group [16.67% (7/42)] and the total recurrence rate [23.81% (10/42)] were significantly higher than those in the non-stricture group [3.33% (2/60), 8.33% (5/60)], the differences were statistically significant ( P<0.05). One year after operation, the physiological function (67.42±9.64), physiological function (71.35±10.16) and overall health score (73.49±10.31) were significantly lower than those in the non-stricture group (76.39±9.42, 75.34±9.26, 79.86±10.24), the differences were statistically significant ( P<0.05). Conclusion:The occurrence of ureteral stricture after pneumatic ballistic lithotripsy increases the risk of recurrence in patients with ureteral stones. Identifying the risk factors that affect patients with ureteral stricture after surgery is conducive to timely and effective intervention measures to improve the prognosis and quality of life of patients.
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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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Objective: To explore the effect of therapeutic application of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound and holmium laser lithotripsy for complex kidney stone. Methods: 124 patients with complex renal calculus were selected and divided into observation group (62 cases) and control group (62 cases) as randomly number table. The patients of observation group were cured by pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound while patients of control group were cured by holmium laser lithotripsy. A series of correlative indicators, such as some correlative indexes in during and post operation, complication situation of post operation and kidney function, were compared. Results:The differences about bleeding volume during operation and postoperative hospital stay between the two groups were significant (t=12.475, t=7.659, P<0.05). For clearance rate of calculus and incidence of complication, the differences between the two groups were significant (x2=6.048, x2=7.159, P<0.05). And the differences of separation index of renal pelvis collective system, creatinine and urea nitrogen post treatment between the two groups also were significant (t=8.529, t=7.058, t=10.596, P<0.05). Conclusion: Comparing with the traditional holmium laser lithotripsy, the clinical better effect of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound for complex renal calculi is significant. Its series of advantages, such as shorter operation time, faster recovery, safer and reliable for patients and lower incidence of postoperative complication and so on, can effectively relieve the renal function for patients.
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Objective:To explore the reliability, availability and security of peel-away plastic film sheath combination of ureteroscopy pneumatic lithotripsy treatment of female lower segment complexity ureteral calculi.Methods: The treatment group(40 cases) used peel-away plastic film sheath establish a bridge sheath channel between the urethra, bladder and the ureteral opening, combining under ureteroscopy pneumatic lithotripsy treatment. The control group(40 cases) with traditional under ureteroscopy pneumatic lithotripsy treatment. The clinical data of two groups of patients were analyzed.Results: The cure rate of the treatment group was significantly higher than the control group(x2=5.54,P<0.05); and the stones operation time, the bleeding, hospital stays and hospital costs was much better than control group; the complications of surgery (except the ureteral perforation) was significantly less than that of control group.Conclusion: Treatment of female lower segment complexity ureteral calculi by using the peel-away plastic film sheath establish a bridge sheath channel between the urethra, bladder and the ureteral opening, combining under ureteroscopy pneumatic lithotripsy treatment, with safe, convenient, practical, low cost, little injury, fewer complications, etc. was worthy of clinical application.
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@#ObjectiveTo investigate the therapeutic effects, safety of pneumatic lithotripsy and 2 μm laser via transurethral ureteroscope for ureteral calculi accompanied with granulation. Methods27 cases (30 sides) of ureteral calculi accompanied with granulation treated with 2 μm laser and pneumatic lithotripsy via ureteroscope were reviewed. Results28 sides were fragmented successfully in a single procedure. The operation time was 15～45 min (mean 25 min). The intraoperative blood loss was 3～15 ml (mean 5 ml). The postoperative hospitalization time was 3～7 d (mean 5.5 d). 1 upper ureteral stone was pushed back to the renal pelvis and extracorporeal shock wave lithotripsy was needed. The insertion of the ureteroscope was failed in 1 cases, who accepted open operation finally. Double-J tubes were pulled out in all the patients after 1 month, and 26 sides were stone-free. They were followed-up for 3～15 months (mean 8 months), no ureteral stenosis or urinary infection was found. Conclusion2 μm laser and pneumatic lithotripsy via ureteroscope is an effective and safe therapy for ureteral calculi with granulation, especially for those on middle or lower levels.
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Objective To evaluate the clinical effectiveness of ureteroscopic pneumatic ballistic lithotripsy for the treatment of ureteral stones.Methods A total of 185 patients with ureteral stones(accompanying renal colic in 96 patients) were treated with ureteroscopic pneumatic ballistic lithotripsy from February 2004 to March 2005 in this hospital. Results The procedure failed in 12 patients,including conversions to open surgery in 6 patients and to extracorporeal shock wave lithotripsy 3 days later in 6 patients.The single-session success rate was 93.5%(173/185),and was 75.0%(24/32) in the upper segment,95.8%(46/48) in the middle segment,and 98.1%(103/105) in the lower segment.The success rate in patients with renal colic was 100%(96/96).The rate of intraoperative ureteral injury was 2.9%(5/173),with conversions to open surgery required in 3 patients(1.7%).Postoperative renal colic occurred in 1 patient.Follow-up checkups in all the patients for 6~12 months(mean,10.2 months) showed no recurrence. Conclusions Ureteroscopic pneumatic ballistic lithotripsy is safe and effective,being the first choice for patients with middle or lower ureteral stones,especially accompanying renal colic.
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Objective To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods Under the guidance of B-ultrasonography,a F_(24) working channel for percutaneous nephroscopy was established.Renal stones were fragmented and extracted under a F_(20.8) nephroscope by using the LithoClast Master(EMS,Switzerland).Results The time for unilateral complete stone clearance was 5~115 min(mean,35 min).All the stones were successfully fragmented and the stone clearance rate was 91.8%(45/49).The renal fistulization tube was removed at 4~6 days after operation and the urethral catheter was removed 2 days afterwards.The double-J tube was removed at 1 month after operation.The postoperative hospital stay was 4~6 days(mean,8 days).Residual stones
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Objective To investigate therapeutic effects of transurethral ureteroscopic pneumatic lithotripsy(TUPL).Methods A retrospective analysis was made on 320 cases of ureteral calculus treated with TUPL from September 2002 to August 2005.A Wolf F9.8 rigid ureteroscope and an EMS pneumatic ballistic lithotriptor were used.The probe was 0.8 mm or 1.0 mm in diameter.The pulse settings was 200~300 kPa.The fragmentation was conducted with single or multiple episode of treatment.Results The stone was pushed back to the renal pelvis in 6 cases and a conversion to extracorporeal shock wave lithotripsy(ESWL) was needed.The insertion of the ureteroscope was failed in 5 cases and a conversion to open surgery was required.The TUPL time was 2~10 min(mean,5.5 min) and the intraoperative blood loss was 3~15 ml(mean,7 ml).The stones were successfully fragmented on one session in 309 cases,the success rate being 96.6%(309/320).The length of postoperative hospital stay was 3~7 d(mean,4.5 d).There were 24 cases of mucosal injury of the ureter and 4 cases of false passage,all of which were cured with double-J catheter indwelling for 1 month.Follow-up examinations for 1~10 months(mean,4 months) showed stone clearance within 1 month and no ureteral stenosis or urinary infection.Conclusions Transurethral ureteroscopic pneumatic lithotripsy for the treatment of ureteral calculus is safe and effective.
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Objective To discuss the technique and therapeutic effect of pneumatic ballistic lithotripsy for the treatment of bladder calculi under ureteroscope via the outer sheath of resectoscope.MethodsTotally 42 patients with bladder calculi(39 men and 3 women)were treated in our hospital form March 2002 to February 2005.Among the patients,20 cases were complicated with BPH,and 3 had bladder fabrosis.The cystolith was crushed with pneumatic ballistic lithotripsy under an ureteroscope via the outer sheath of resectoscope.For the patients complicated with BPH(20 cases),prostatectomy was performed at the same time.ResultsAll the cases were cured in one session.No massive hemorrhage,bladder perforation,or overhydration occurred after the operation in this series.The patients were followed up for 6 to 18 months(mean 8 months),during which no recurrent cases were found,all the patients had normal urination.ConclusionsPneumatic ballistic lithotripsy via the outer sheath of resectoscope is an effective,simple,accurate method for the treatment of bladder stones.The procedure is superior in less complications and good outcomes.
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Objective To compare the efficacy of three procedures,extracorporeal shock wave lithotripsy(ESWL),ureteroscopic lithotripsy(URL) combined with ESWL,and minimally invasive percutaneous nephrolithotomy(MPCNL),for the treatment of complicated upper ureteral calculi.Methods Two hundred and thirty-four cases of complicated upper ureteral calculi were treated in this hospital from December 2002 to December 2003,including 76 cases of ESWL,78 cases of combined use of URL and ESWL,and 80 cases of MPCNL.Results In the ESWL cases,the stone fragmentation rate on one session was 56.6%((43/76),) the stone-free rate one month after operation was 46.1%(35/76),the mean hospitalization expenditure was 912 yuan,and the incidence of postoperative complications was 15.8%(12/76).In the URL combined with ESWL cases,the stone fragmentation rate on one session was 100%(78/78),the stone-free rate one month after operation was 83.3%(65/78),the mean hospitalization expenditure was 7 720 yuan,and the incidence of postoperative complications was 15.4%(12/78).In the MPCNL cases,the stone fragmentation rate on one session was 100%(80/80),the stone-free rate one month after operation was 100%(80/80),the mean hospitalization expenditure was 10 253 yuan,and the incidence of postoperative complications was 13.8%(11/80).The operation time,intraoperative blood loss,length of hospital stay,stone-free rate one month after operation,and hospitalization expenditure were significantly greater in the MPCNL cases than in the ESWL cases and the URL combined with ESWL cases.The stone fragmentation rate on one session was not significantly different between the MPCNL cases and the URL combined with ESWL cases,and was significantly higher in the MPCNL cases and the URL combined with ESWL cases than in the ESWL cases.The incidence of postoperative complications was not significantly different among the three groups.Conclusions Minimally invasive percutaneous nephrolithotomy should be used as the first choice for complicated upper ureteral calculi.
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Objective To investigate a new method of pneumatic ballistic lithotripsy for the treatment of bladder calculi. Methods A ureteroscope or nephroscope was inserted into the bladder via outer sheath of resectoscope. Then pneumatic ballistic lithotripsy was performed under endoscope to fragment and remove bladder stones. Results Stones were thoroughly removed from the bladder on one session in all 20 patients. No major haemorrhage, perforation of the bladder, or water intoxication happened intraoperatively or postoperatively. Follow-up for 2~18 months (mean, 4 6 months) in the 20 patients showed no recurrence of calculi under B-ultrasonography or symptoms of urethral stricture like dribble urination. Conclusions Pneumatic ballistic lithotripsy via outer sheath of resectoscope is effective in the treatment of bladder calculi.