ABSTRACT
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.
Subject(s)
Infant , Humans , Hypercalciuria/genetics , Kidney Calculi/genetics , Urolithiasis/genetics , Nephrocalcinosis/genetics , Metabolism, Inborn Errors/geneticsABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Objective:To observe the reliability and clinical implement of flexible ureteroscope combined with extracorporeal shock wave lithotripsy to treat the kidney stones with a diameter of more than 2cm. Methods:The diagnosed 80 cases of kidney stones (all with a diameter of more than 2cm) patients in our hospital were chosen, randomly divided into two groups, URL group and PCNL group,each of them with 40 cases. Surgical curative effect, operation time, postoperative complications, hospitalization days and the change of NGAL levels and the change of urine levels Kim-1 preoperative and postoperative blood 3 days of two groups were observed and compared. Results: Comparing with the PCNL group, the surgical curative effect, operation time and postoperative complications of the URL group have no significant difference, but the hospitalization days between are significantly different(t=8.433, P<0.05);In terms of NGAL, Kim-1, the postoperative 1d of PCNL group is significantly higher than preoperative, NGAL postoperative 1d of URL group is significantly higher than preoperative (t=3.319, P<0.05). Conclusion:It was reliable that flexible ureteroscope combined with extracorporeal shock wave lithotripsy to treat the kidney stones with a diameter of more than 2cm, lower complication rate, worthy of clinical.
ABSTRACT
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.
ABSTRACT
Objective To compare the safety and efficacy between flexible ureteroscope lithtripsy (FURL) and percutaneous nephrolithotomy (PCNL) in treating the renal calculus.Methods From Jan.2012 to Oct.2013,120 male and 87 female patients with renal calculus were accepted FURL (n =108)or PCNL (n=99) in our hospital.In FURL group,108 cases were classified according to the diameter of the stone,including 33 patients with the diameter of renal stone more than 20mm (range 20-39 mm,mean 29.2±5.6 mm)and 75 patients with the diameter of renal stone less than 20 mm (range 13-19 mm,mean 16.8± 1.3 mm).In PCNL group,99 cases were also classified according to the diameter of the stone,including 51 patients with the diameter of renal stone more than 20 mm (range 20-45 mm,mean 30.4±6.6 mm)and 48 patients with the diameter of renal stone less than 20 mm (range 14-19 mm,mean 17.2±1.4mm).There were no significant differences between the groups FURL and PCNL in the stone size(P＞0.05).Demographic data,operative duration,postoperative hospital stay,complication rate,and stone-free rate were recorded and compared.Results The overall stone free rate in group FURL was significantly lower 80.6％ (87/108) than that in group PCNL 91.9％ (91/99) (P＜0.05).In those patients with the diameter of stones less than 20 mm,the stone free rate was 88.0％ (66/75) in group FURL vs 93.8％ (45/48) in group PCNL (P＞0.05).The operative time was 30-65 (mean 49.5±6.9) min and 30-65 (mean 46.9±7.2) min in FURL and PCNL group,respectively (P＞0.05).In those patients with the diameter of stones more than 20 mm,the stone free rate was 63.6％ (21/33) in group FURL,which was lower than that in group PCNL 90.2％ (46/51) (P＜0.05).The operative time was 60-115 min (85.0±16.3) min and 30-95 min (68.3± 16.7) min in FURL and PCNL group,respectively (P＜0.05).The overall complication rate was significantly lower in group FURL 2.8％ (3/108) compared to group PCNL 8.1％ (8/99) (P＜0.05).Postoperative hospitalization stay were 2-6 d (3.5±1.4) d and 3-9 d (5.8±1.9) d in FURL and PCNL group,respectively (P＜0.05).Conclusions Both PCNL and FURS are efficacy and safe surgical alteration for patients with renal calculus.As to the FURS,its merits were faster recovery,less invasiveness than those in PCNL.Therefore,it can be considered as the first-line treatment for renal calculus ＜20 mm.However,for renal calculus ≥20 mm stones,FURS is still effective.