Comparison of Efficacy Between Prone Split-leg Position and Traditional Prone Position Percutaneous Nephrolithotomy for Upper Urinary Tract Stones / 中国微创外科杂志

Objective To explore the application effect of prone split-leg position in percutaneous nephrolithotomy(PCNL).Methods A total of 79 patients with upper urinary tract stones who underwent surgery in our department from July 2021 to July 2022 were selected.According to the surgical position,the patients were divided into prone split-leg position group(n =35)and traditional prone position group(n =44).The two groups were compared regarding operation time,intraoperative blood loss,postoperative and preoperative hemoglobin changes,postoperative complications,one-stage stone free rate,and duration of hospitalization.Results The prone split-leg position group had significantly shorter operative time and higher one-stage stone free rate than those in the traditional prone position group[(69.6±20.7)min vs.(90.5±35.3)min,t =-3.280,P =0.002;97.1%(34/35)vs.79.5%(35/44),χ2 =3.984,P =0.037].There were 1 case of infection,3 cases of fever,and 1 case of bleeding in the prone split-leg position group,while 4 cases of postoperative fever and 2 cases of bleeding in the traditional prone position group,without significant difference in the incidence of complications between the two groups(χ2 =0.000,P =1.000).There were no statistical differences in intraoperative blood loss,number of working channel,hemoglobin changes,and duration of hospitalization(P>0.05).Conclusion Prone split-leg position PCNL can shorten the operation time,improve the one-stage stone free rate,and will not increase the risk of postoperative complications,with good safety and effectiveness.

Macrophage polarization in calcium oxalate nephrolithiasis:unraveling its role and influencing factors / 中国病理生理杂志

The most prevalent kind of renal calculi,calcium oxalate(CaOx),is characterized by its propensi-ty for recurrence in the urinary system.The development of CaOx renal calculi is greatly affected by macrophage polariza-tion.Particular oxalate causes an imbalance in macrophage polarization,which skews the M1/M2 ratio and makes it easier for CaOx crystals to accumulate in the kidneys and grow into calcium plaques in the renal papilla.Notably,M2 macro-phages can prevent CaOx renal calculi by consuming crystals and reducing inflammatory stress.As a result,immunothera-peutic techniques that alter M1 and M2 macrophage polarization are extremely promising for preventing CaOx renal calcu-li.To clarify the respective roles of M1 and M2 macrophages in the formation of CaOx crystals and provide insights for de-veloping immunotherapeutic interventions against CaOx renal calculi,this review summarizes the mechanisms underlying macrophage polarization in the genesis of CaOx renal calculi.

Research progress on renal calculus associate with inborn error of metabolism / 浙江大学学报·医学版

Renal calculus is a common disease with complex etiology and high recurrence rate. Recent studies have revealed that gene mutations may lead to metabolic defects which are associated with the formation of renal calculus, and single gene mutation is involved in relative high proportion of renal calculus. Gene mutations cause changes in enzyme function, metabolic pathway, ion transport, and receptor sensitivity, causing defects in oxalic acid metabolism, cystine metabolism, calcium ion metabolism, or purine metabolism, which may lead to the formation of renal calculus. The hereditary conditions associated with renal calculus include primary hyperoxaluria, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis, Bartter syndrome, primary distal renal tubular acidosis, infant hypercalcemia, hereditary hypophosphatemic rickets with hypercalciuria, adenine phosphoribosyltransferase deficiency, hypoxanthine-guanine phosphoribosyltransferase deficiency, and hereditary xanthinuria. This article reviews the research progress on renal calculus associated with inborn error of metabolism, to provide reference for early screening, diagnosis, treatment, prevention and recurrence of renal calculus.

Recent advances in the risk factors, diagnosis and evaluation of renal calculus / 上海交通大学学报（医学版）

Renal calculus is a common disease of urinary system. Calculus formation is associated with dietary factors, genetics, comorbidities, microorganism environment, modulators in the urine and many other factors. It has become a kind of chronic metabolic condition which needs multidisciplinary treatment. Imaging, metabolic evaluation and calculus analysis provide a variety of tools for calculus diagnosis and evaluation. As the first-line imagine examination recommended by guidelines, CT has advantages in distinct sectional anatomy with high sensitivity and specificity, and dual-energy CT makes it possible to discriminate different calculus compositions noninvasively. The 24-hour urine test can help predict the risk of renal calculus. This article reviews recent research progresses in the risk factors, diagnosis and evaluation of renal calculus.

Laparoscopic management of urinary tract calculi: uncommon but effective alternative to open surgery in certain situations

Introduction: The use of minimally invasive techniques has helped decrease the morbidity and convalescence associated with the management of urolithiasis. In this regard laparoscopy has also developed as one of the modalities. However, in comparison with other surgeries, laparoscopy for stone removal is relatively uncommon. Here we present our experience of laparoscopic stone surgeries. Materials and methods: 10 patients with large renal and ureteric calculi where planned for laparoscopic surgery. Three patients had 2-3 cm proximal ureteric calculi, 2 patients had > 3cm renal pelvic calculi, 2 patients had multiple renal calculi associated with PUJ Obstruction, 2 patients had pelvic calculi in ectopic kidneys and one patient had calculus in crossed fused ectopia. Results: All the patients had a smooth intra-operative course. Post-operative period was uneventful except for one patient with crossed fused ectopia. One of the patients with PUJ obstruction had a single residual calculus which was managed with ESWL on follow up. Conclusions: Laparoscopic approach can be an effective alternative to endourological or open procedures for stone removal. It can be utilized for stone management in urinary tract where ESWL, PCNL and ureteroscopy have failed or deemed unsuitable. It is also a good option in patients with unusual anatomy such as ectopic kidney.

Initial experience of modified transperitoneal laparoscopic pyeloplasty combined with a rigid ureteroscope with a deflectable tip(Sun's ureteroscope) for the treatment of ureteropelvic junction obstruction with renal calculi / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction (UPJO) complicated with renal calculi.Methods From January 2018 to September 2018,eight patients,including five males and three females,were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University.The age ranged from 14 to 50 years(mean 28 years).Four patients had flank pain and one patient had flank pain with hematuria,while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m2 (mean 22.0 kg/m2).The lesion located on the left side in 4 cases and on the right side in 4 cases.One patient suffered with multiple pelvis stones.Four patients suffered with multiple lower calyceal stones,and 3 patients had solitary lower calyceal stone.The stone size ranged from 2 mm to 10 mm (mean 6.4 mm).3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis.Two patients combined with crossing vessels.All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy.In cases with left lesion,an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum.A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle.Then,a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle.Another 12 mm operative trocar was inserted at the opposite McBurney point.The last 5 mm operative trocar was placed at the veress needle point.After visualizing the pelvis and the proximal ureter at the lower pole of the kidney,a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made.The Sun's ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus.Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port.After the pyelo-nephroscopy,a modified transperitoneal laparoscopic pyeloplasty was made.A F6 double-J stent was inserted into the ureter during the surgery.Result All surgeries were finished successfully without conversion.The surgical duration ranged from 111 to 185 min(mean 135 min).The estimated blood ranged from 10 to 50 ml(mean 38.8 ml).The hospital stay ranged from 3 to 7 days(mean 4 days).The intraoperative stone free rate was 100％ (8/8).No perioperative complications occured.With the follow-up from 6 to 14.4 months(mean 8.9 months),there was no evidence of obstruction in all patients,as confirmed by symptoms or radiological improvement of hydronephrosis,and two patients found recurrence of renal calculi.Conclusions Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope (the Sun's ureteroscope) is a safe,effective method to manage ureteropelvic junction obstruction with renal calculi.

Initial experience of modified transperitoneal laparoscopic pyeloplasty combined with a rigid ureteroscope with a deflectable tip( Sun’s ureteroscope) for the treatment of ureteropelvic junction obstruction with renal calculi / 中华泌尿外科杂志

Objective@#To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction(UPJO) complicated with renal calculi.@*Methods@#From January 2018 to September 2018, eight patients, including five males and three females, were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University. The age ranged from 14 to 50 years(mean 28 years). Four patients had flank pain and one patient had flank pain with hematuria, while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m2(mean 22.0 kg/m2). The lesion located on the left side in 4 cases and on the right side in 4 cases. One patient suffered with multiple pelvis stones. Four patients suffered with multiple lower calyceal stones, and 3 patients had solitary lower calyceal stone. The stone size ranged from 2 mm to 10 mm (mean 6.4 mm). 3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis. Two patients combined with crossing vessels. All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy. In cases with left lesion, an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum . A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle. Then, a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle. Another 12 mm operative trocar was inserted at the opposite McBurney point. The last 5 mm operative trocar was placed at the veress needle point. After visualizing the pelvis and the proximal ureter at the lower pole of the kidney, a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made. The Sun’s ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus. Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port. After the pyelo-nephroscopy, a modified transperitoneal laparoscopic pyeloplasty was made. A F6 double-J stent was inserted into the ureter during the surgery.@*Result@#All surgeries were finished successfully without conversion. The surgical duration ranged from 111 to 185 min(mean 135 min). The estimated blood ranged from 10 to 50 ml(mean 38.8 ml). The hospital stay ranged from 3 to 7 days(mean 4 days). The intraoperative stone free rate was 100%(8/8). No perioperative complications occured. With the follow-up from 6 to 14.4 months(mean 8.9 months), there was no evidence of obstruction in all patients, as confirmed by symptoms or radiological improvement of hydronephrosis, and two patients found recurrence of renal calculi.@*Conclusions@#Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun′s ureteroscope) is a safe, effective method to manage ureteropelvic junction obstruction with renal calculi.

Comparative study of clinical effect of percutaneous nephrolithotomy and flexible ureteroscope lithotripsy in the treatment of renal calculus ≤2 cm / 中国综合临床

Objective To compare the effect, postoperative inflammatory response, stress response differences of percutaneous nephrolithotomy ( PCNL) and flexible ureteroscopic lithotripsy ( FURL) in the treatment of renal calculus with a diameter ≤2 cm. Methods One hundred and twenty-eight patients with renal calculus ≤2 cm m in Beijing Pinggu Hospital were enrolled in the study and were randomly divided into PCNL group( 64 cases ) and FURL group ( 64 cases ) . The treatment of PCNL and FURL was carried out respectively. The stone clearance rate,operation time,hospitalization time,the number of painkillers used after surgery,inflammatory index ( hs-CRP,IL-6),oxidative stress index ( MDA,SOD) were compared. Results There was no significant difference in the stone clearance rate between PCNL group and FURL group ( χ2= 0. 208,P>0. 05). The operation time of PCNL group was (55. 32±5. 80) min,which was shorter than that of FURL group ((65. 21± 4. 24) min), the difference was statistically significant ( t = 16. 322,P< 0. 01) . The hospitalization time of FURL group was (4. 50±1. 20) d,which was shorter than that of FURL group ((7. 40 ±1. 80)),the difference was statistically significant (t= 9. 441,P<0. 01). The number of painkillers used after surgery in the FURL group was (0. 35±0. 14) times,which was less than that in FURL group ((0. 85±0. 24) times),the difference was statistically significant ( t = 8. 625,P < 0. 01) . The postoperative hs-CRP of FURL group (10. 62±1. 26) mg was significantly lower than that in PCNL group (19. 42±1. 35) mg/ L,The difference was statistically significant (t= 12. 734,P<0. 01) . The postoperative IL-6 of FURL group was(31. 50±6. 57) ng/ L,significantly lower than the PCNL group(38. 72±6. 25) ng/ L,the difference was statistically significant (t= 5. 839,P<0. 01). The postoperative MDA of FURL group (0. 63±0. 17) mmol/ L was significantly lower than that of the PCNL group (0. 80±0. 20) mmol/ L,The difference was statistically significant (t= 4. 288,P<0. 01) . The postoperative SOD of FURL group (80. 40± 5. 80) U/ L was significantly higher than the PCNL group (74. 30± 7. 40) U/ L, the difference was statistically significant ( t = 4. 691, P <0. 01). The incidence of postoperative complications in PCNL group was 10. 94% ( 7/ 64), FURL group was 2. 17% ( 1/ 64), the difference was statistically significant (χ2 = 4. 800,P<0. 01). Conclusion FURL has the characteristics of less intraoperative blood loss,less trauma,less postoperative pain and fewer complications in the treatment of renal calculus ≤ 2 cm, which has less smaller inflammation, oxidative stress, and conducive to the patients' postoperative recovery.

Lithagogue effects of Pyrrosia lingua from Guizhou province on experimental renal calculus in rats / 中国中药杂志

To screen the active fractions with lithagogue effects of Pyrrosia lingua from Guizhou province and preliminarily investigate its mechanism. The rats were fed with 1% ethylene glycol and 2% ammonium chloride to establish the nephrolithiasis models, which were used to evaluate thelithagogue effects of different polar fractions of P. lingua from Guizhou province. The level of urinary calcium and oxalic acid in urine, renal calcium, oxalic acid, superoxide dismutase (SOD), catalase(CAT) and malondialdehyde (MDA) in renal tissues,as well as crystalline deposit and lithogenesis in renal tissues and the levels of creatinine(Cr) and blood urea nitrogen (BUN) in the serum were detected. The effective compounds were inferred from the analysis of active fractions extract based on LC-MS technology. Petroleum ether fraction and dichloromethane fraction of P. lingua from Guizhou province can reduce renal oxalic acid and renal calcium concentration, increase urinary oxalic acid and urine calcium, with significant inhibitory effect on the formation of renal calculus in rats, significantly increase SOD and CAT activities in renal tissues, and significantly reduce MDA levels. LC-MS analysis showed that the caffeine, citric acid and tartaric acid among the compounds from petroleum ether fraction and dichloromethane fraction had lithagogue effects. Both the petroleum ether fraction and dichloromethane fraction of P. lingua from Guizhou province showed good effect on prevention and treatment of calculus in middle dose groups, and the mechanism may be associated with antioxidation, reducing calcium oxalate crystal deposition, and promoting calcium oxalatecrystal release, in addition, caffeine, citric acid and tartaric acid had lithagogue effects.

A research: therapeutic application of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound and holmium laser lithotripsy for complex renal calculus / 中国医学装备

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.

Clinical study on flexible ureteroscopy lithotripsy for concurrent treatment of bilateral upper urinary tract calculi / 重庆医学

Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 ％ (35/43).SFR was 100％ in the patients with the stone burden less than 30 mm and 63.2％ in the patients with the stone burden ≥30 mm,the difference was statistically significant(P＜0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden ＜30 mm,which has higher stone clearance rate with good safety.

Clinical efficacy of digital flexible reteroscope and modular flexible ureteroscope combined with holmium laser lithotripsy for subrenal calyx calculus / 中国内镜杂志

Objective To evaluate the efficacy of flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of subrenal calyx calculus, and comparing with digital flexible ureteroscope and modular flexible ureteroscope with holmium lithotripsy for the difference of the efficacy of the treatment of subrenal calyx calculus. Methods Review of the clinical data of 93 patients with subrenal calyx calculus, of which 48 cases were treated with digital flexible ureteroscope (digital flexible ureteroscope group, DFU group), 45 cases with modular flexible ureteroscope treatment (modular flexible ureteroscope group, MFU group), lithotripsy effect and complications were compared between the two groups. Results The mean operation time, one-session stone-free rate were significantly different between the two groups (P < 0.05). No significant differences in hospital stay, the success rate of looking for calculus, complication and hospitalization expense (P > 0.05). Conclusion With digital flexible ureteroscope and modular flexible ureteroscope treatment of subrenal calyx calculus all are safe and effective. The use of DFU than the use of MFU in the treatment of subrenal calyx calculus operation time is shorter, stone-free rateis higher, the effect is better. There is little difference between their hospitalization expenses, but the use of MFU can reduce the cost of the department.

Clinical study on flexible ureteroscopy lithotripsy for concurrent treatment of bilateral upper urinary tract calculi / 重庆医学

Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 ％ (35/43).SFR was 100％ in the patients with the stone burden less than 30 mm and 63.2％ in the patients with the stone burden ≥30 mm,the difference was statistically significant(P＜0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden ＜30 mm,which has higher stone clearance rate with good safety.

Clinical efficacy of digital flexible reteroscope and modular flexible ureteroscope combined with holmium laser lithotripsy for subrenal calyx calculus / 中国内镜杂志

Objective To evaluate the efficacy of flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of subrenal calyx calculus, and comparing with digital flexible ureteroscope and modular flexible ureteroscope with holmium lithotripsy for the difference of the efficacy of the treatment of subrenal calyx calculus. Methods Review of the clinical data of 93 patients with subrenal calyx calculus, of which 48 cases were treated with digital flexible ureteroscope (digital flexible ureteroscope group, DFU group), 45 cases with modular flexible ureteroscope treatment (modular flexible ureteroscope group, MFU group), lithotripsy effect and complications were compared between the two groups. Results The mean operation time, one-session stone-free rate were significantly different between the two groups (P < 0.05). No significant differences in hospital stay, the success rate of looking for calculus, complication and hospitalization expense (P > 0.05). Conclusion With digital flexible ureteroscope and modular flexible ureteroscope treatment of subrenal calyx calculus all are safe and effective. The use of DFU than the use of MFU in the treatment of subrenal calyx calculus operation time is shorter, stone-free rateis higher, the effect is better. There is little difference between their hospitalization expenses, but the use of MFU can reduce the cost of the department.

DSA manifestations and interventional treatment of renal artery with severe hemorrhage following PCNL / 中国内镜杂志

Objective To investigate the digital subtraction angiography (DSA) manifestations and clinical value of interventional embolization of renal artery with severe hemorrhage following percutaneous nephrolithotomy (PCNL).Methods 34 patients with severe hemorrhage following PCNL from Feb 2012 to Jun 2015 were subjected to perform renal arterial DSA, which was followed by super-selective renal arterial embolization (SRAE) with steel micro-coils and guglielmi detachable coils together with or without biological glue (GLUBRAN2). The patients were followed up for 6 ~ 12 months.Results Of the 34 patients, DSA examination showed that renal artery pseudoaneurysm (RAP) was found in 22 (64.7%), renal arteriovenous ifstula (RAVF) in 8 (23.5%) and RAP associated with RAVF in 4 (11.8%). Successful embolization with single session was achieved in all 34 patients. Both the technical success rate and the hemostasis rate were 100.0%. Meanwhile, the renal tissue and function were mainly reserved and no serious complication of embolization was observed. No hematuria recurrence or renal function failure appeared in all patients during the follow-up period. In 26 patients, different degree of embolism syndrome was observed after the treatment.Conclusions Renal artery pseudoaneurysm and renal arteriovenous ifstula are the main types of renal artery injury resulting in severe hemorrhage after percutaneous nephrolithotomy. Super-selective renal arterial embolization (SRAE) with steel micro-coils and guglielmi detachable coils together with or without biological glue (GLUBRAN2) is a minimally invasive method that can promptly stop the renal bleeding, and preserve the renal tissue and function to the greatest possible advantage. Therefore, this technique should be regarded as the ifrst choice in the treatment of the patients who suffered from severe hemorrhage occurred after PCNL.

Efficacy and Safety of Tubeless Percutaneous Nephrolithotomy versus Standard Percutaneous Nephrolithotomy.

Introduction: We conducted a prospective study of tubeless percutaneous nephrolithotomy (PCNL) in selected patients and compared it with standard PCNL among patients with similar inclusion criteria and evaluated the efficacy and safety of tubeless PCNL over the standard PCNL. Methods: Between December 2009 and December 2011, a total of 298 patients underwent PCNL. 40 patients with stone size <2 cm underwent PCNL. In 20 patients, nephrostomy tube (N) was placed, and in another 20 patients, a exteriorized ureteral stent was placed and did not undergo nephrostomy (NN) (tubeless). These two groups were compared regarding the duration of hospital stay, post-operative pain, analgesic duration, complications, and estimated blood loss - hemoglobin (Hb) drop in g% (before and after PCNL). Results: Out of the 40 patients in the study, there were 13 (32.5%) females and 27 (67.5%) males. 7 patients (17.5%) had stones in calyx, 18 (45%) in pelvis, 3 (7.5%) in pelvi-ureteric junction, and 12 (30%) ureter. The mean age of patients was 41.3 year (7-55 years). The average size of stone was 14.38 ± 4.02 mm. The duration of procedure of all patients was 50.13 ± 15.34 min. The duration of the procedure, visual analog pain score, duration of analgesia use, the length of hospital stay, and drop in Hb and found that in patients who underwent tubeless nephrolithotomy it was 38.5 ± 7.8 min, 2.3 ± 0.5 cm, 2.6 ± 0.5 days, 3.5 ± 0.8 days, and 0.3 ± 0.4 g%, respectively. Whereas it was 61.8 ± 11.7 (P < 0.0001), 3.7 ± 1.1 (P < 0.0001), 4.4 ± 0.9 (P < 0.0001), 0.3 ± 0.4, and 0.5 ± 0.5 (P = 0.13), respectively, in patients undergoing standard nephrolithotomy. One patient developed fever in each group. Conclusion: In properly selected patients, tubeless PCNL with only an externalized ureteral catheter demonstrates significant advantages over standard PCNL regarding post-operative discomfort, morbidity, hospital stay, and period of analgesia requirement. In near future, tubeless PCNL with externalized ureteral catheter can be recommended as a standard of care in the management of selected cases of renal calculi.

CT density Is it a predictor in renal calculus clearance with extracorporeal shock wave lithotripsy

Background: Computed tomography of the kidneys, ureters and bladder (CT-KUB) is increasingly used for urinary lithiasis. Its higher sensitivity in detecting small, radiolucent calculi with the avoidance of intravenous contrast media is very beneficial and replacing the traditional intravenous urography. Materials and methods: A Prospective study at Gandhi Hospital, Hyderabed was conducted from August 2013 to January 2016. Study Group I: calculus CT density less than 900 HU and study Group II: calculus CT density more than 900 HU. Results: Most of the stones were located in lower calix, followed by renal pelvis in both the groups. Hematuria persisted more than 24 hours among 6 (6%) patients in group 1 while18 (22.5%) in group 2. Steinstrasse was seen in 8 patients among group 1 which was managed medically in 6 patients where as ureteric stenting required in 2 patients .Where it was 3 patients in group 2 among them 1 required ureteric stenting, which appears to be significantly low but it was not when calculated among successful fragmentation as it is secondary complication to fragmented caliculi drainage. Conclusion: In patients with CT density <900 HU the ESWL was successful in 88%, with 58% of the patients required only one session and two or three ESWL sessions in remaining; with mean no 1.58 ESWL sessions are required. In patients CT density >900 HU, ESWL was successful in fewer than half of the patients (44%), only13% of them in a single session, and 76% requiring three sessions with failure rate of 80% in that group.

Treatment of ultrasonography guidance percutaneous nephrolithotomy Ⅰ period combining pneumatic ultra-sosonic and holmium laser lithotrips in 120 cases of complex renal calculi / 中国基层医药

Objective To assess the clinical efficacy of ultrasonography guidance percutaneous nephrolithot-omyⅠ period combining pneumatic ultrasosonic and holmium laser lithotrips of complex renal calculi.Methods Patients were under the general anesthesia in lithotomy position.By cystoscope first to one side retrograde insertion F5 ureteral catheter,the position to prone position was changed.Under ultrasonography guidance puncture target after the success of the calyx,fascia dilator gradually expanded from F8 to F20 channel was established.Then percutaneous nephroscope combining pneumatic ultrasosonic and holmium laser lithotripsy were administrated.Results One sided single channel was 92 cases,one sided dual channel was 11 cases,one sided three -channel was 1 case.On both sides single channel was 13 cases,one side of the dual channel and other side of the single channel was 3 cases.The operation time was (72 ±24)min.Intraoperative bleeding was in 50 -150mL,with an average of 80mL,and there's no intraoper-ative blood transfusion.2 cases of postoperative had secondary bleeding,in which 1 case remitted after non -operative treatment,the other case was treated in DSA downward super selective renal artery embolization to stop the bleeding. Postoperative hospital stay was 7 -14d,with an average of 10d.There were no septic shock,water uptake,water intoxi-cationand complications such as pleural effusion.One week after the CT,stones free rate was 91.7%(110 /120),in which 10 cases of residual stone with diameter <5mm,needn't surgery removed again.They were treated with oral platoon stone drugs,drinking lots of water and a moderate amount of sports such as processing.All cases were followed up for 6 months to 18 months,with no urinary tract infection,stone recurrence and the long -term complications such as perinephric space effusion.Conclusion As long as establish proper percutaneous renal channel,with intraoperative operating norms,combining pneumatic ultrasosonic and holmium laser,ultrasonography guidance percutaneous nephro-lithotomy Ⅰ period clear renal calculi is completely can be done.And it can shorten operation time,and has clear renal calculi with high efficiency,small trauma and less long -term complications.It is safe and effective,and worthy of clinical popularization and application.

Treatment and effect of donor kidney with single calculus in living renal transplantation / 器官移植

Objective To explore treatment methods of donor kidney with single calculus in living renal transplantation and their effect.Methods The treatment experience of donor kidneys with unilateral renal calculus in living renal transplantation of 3 cases was summarized,which were diagnosed before operation.The kidney with renal calculus was excised as the donor kidney;ureteroscopic lithotomy was conducted in vitro,and then renal transplantation was performed by routine operation.Results There was no early complication such as delayed graft function and acute rejection in 3 recipients after operation.Three pairs of donors and recipients were followed up for 34,45 and 62 months respectively.The color Doppler ultrasound examination of urinary system after renal transplantation showed that,new renal calculus and urinary tract obstruction did not occur in donor's preserved kidneys and recipient's transplant kidneys.Renal function of all donors and recipients was good.Three donors were followed up until now,and no abnormal urine routine was discovered.One recipient developed IgA nephropathy,which was considered to be recurrent nephropathy and had nothing to do with renal calculus.Conclusions The donor kidney with single calculus in living renal transplantation can be treated effectively by ureteroscopic lithotomy in vitro after donor kidneys are excised.

Risk factors for infection following percutaneous nephrolithotomy / 中国感染控制杂志

Objective To explore the risk factors for infection following percutaneous nephrolithotomy(PCNL), and provide the basis for prevention of postoperative infection.Methods 96 patients who were performed PCNL in a hospital between August 2010 and August 2013 were chosen,clinical data of patients were retrospectively analyzed, the occurrence of postoperative infection,risk factors and isolated pathogens were analyzed.Results 35 patients (36.46%[35/96])developed infection following PCNL.Univariate analysis revealed that risk factors for postopera-tive infection were the size and shape of stone,duration of operation,and intraoperative perfusion (all P <0.05). 96 patients before operation and 18 patients after operation were performed bacterial culture for urine,a total of 39 strains were isolated,the main isolated pathogens was Escherichia coli (n=12),followed by Pseudomonas aerugi-nosa (n=8),Streptococcus viridans (n =5 ),Klebsiella pneumoniae (n =4)and Enterobacter cloacae (n =3 ). Conclusion Infection rate following PCNL is high,duration of operation and intraoperative perfusion should be re-duced,antimicrobial agents should be used rationally.