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Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.
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【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.
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【Objective】 To investigate the safety and efficacy of flexible vacuum aspiration ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal and upper ureteral calculi. 【Methods】 Clinical data of 41 cases treated in our hospital were retrospectively analyzed, including 20 cases treated with flexible vacuum aspiration ureteral access sheath (experimental group), and 21 cases treated with traditional ureteral access sheath (control group). The stone-clearance rate, operation time, postoperative fever (T>37.5 ℃), length of hospital stay and hospitalization costs were compared between the two groups. 【Results】 All operations were successful. The experimental group had significantly shorter operation time than the control group [(54.0±19.8) min vs. (76.6±20.1) min, P0.05). 【Conclusion】 Flexible vacuum aspiration ureteral access sheath in flexible ureteroscopic lithotripsy can shorten the operation time, improve stone-clearance rate and reduce incidence of postoperative fever, which is worth promoting.
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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 investigate the duration of indwelling ureteral stent after the ureteroscopic lithotripsy.Methods 300 cases of patients were retrospectively analyzed from June 2015 to June 2017,including 168 with renal calculi and 132 with non-incarcerated upper ureteral calculi.The size of stone is ＜2 cm in diameter.According to the length of time for indwelling ureteral stent,all patients were divided into two groups-150 cases in 14-day group (Group A) and 150 in the 28-day group (Group B) for comparing the complication and outcome,and then received modular flexible ureteroscopic lithotripsy combined with holmium laser.Lastly,6F ureteral stent was indwelling postoperatively.Results Complications happened in both two groups after stenting.There were 140 cases (93.3％) complained of bladder irritation symptoms (LUTS) in Group A,while 107 (71.3％) in Group B;85 cases (56.7％) suffered from flank or abdominal pain in Group A and 36 (24％) in Group B;gross hematuria happened in 133 cases (88.7％) of Group A and 60 cases (40％) of Group B.As the duration of indwelling ureteral stent extended,the incidence of complications increased,significantly (P ＜ 0.05).CT scan showed there was no statistical difference in stone-free rate (diameter ＜ 3 mm) of two groups [A group:91.3 ％ (137/150) vs.B group:89.3 ％ (134/150),respectively].Conclusion With high stone-free rate and low complication incidence,2-week indwelling ureteral stent is safe for patients suffered from renal calculi or non-incarcerated upper ureteral calculi (diameter ＜ 2 cm).
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ObjectiveTo evaluate the methods in treatment of upper urinary calculi in a low-head lithotomy with right or left lateral tilt by an ureteroscopy approach. Methods From September 2009 to May 2015, 110 patients with upper ureteral calculi (after failed ESWL) were underwent holmium laser lithotripsy by a ureteroscopy approach in a low-head lithotomy with right or left lateral tilt. Their clinical data and complications were analyzed retrospectively. Results Surgical effect of patients was satisfied with the success of gravel 91 patients, with a total rate of 82.7 %gravel. Conclusion Low-head lithotomy with right or left lateral tilt is a good body position to perform ureteroscopic lithotripsy for upper ureteral calculi. It is safe and effective.
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Objective To evaluate the efficacy and safety of tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of upper ureteral calculi in paediatric patients. Methods 20 cases of children with upper ureteral calculi (age≤7 years old), in our hospital underline of modular flexible ureteroscope combined with ultramini nephrostomy tract lithotripsy, the stones located on the left side in 12 cases, 8 cases on the right. The average age of children in the 4 years (2 to 7 years), the average diameter of stones 1.0 cm (0.7 ~1.5 cm), multiple 9 (including 3 cases of multiple bilateral, 6 cases of unilateral multiple) single stones 11 cases. Ultrasound-guided percutaneous nephrolithotomy establish supermicro channel (F11), application modular and flexible uretero﹣scope holmium laser lithotripsy systems. Results Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract calculi Clear Phase 91%(21/23), 2 cases of bilateral stones with phased surgical treatment, surgi﹣cal staging stone clearance rate was 100 % (23/23). Postoperative hemoglobin decline was no significant change. Children do not need a blood transfusion, creatinine, blood urea nitrogen and CRP were no significant differences in change, not placed before and after surgery and renal fistula DJ tube (no tube-based). The mean postoperative hospi﹣tal stay was two days, followed up for 6 months to 1 year, all patients had no long-term complications. Conclusion Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of Upper ureteral calculi in paediatric patients is an effective and safety method, can shorten hospital stay.
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Objective To evaluate the efficacy and safety of double-J stents in extracorporeal shock wave lithotripsy for the treatment of middle and upper ureteral calculi, and to explore the reasonable application of double-J stents. Methods 511 patients with middle and up-per ureteral calculi in our hospital were selected as the statistical objects. 161 patients of the catheter group were indwelled double-J stent be-fore extracorporeal lithotripsy while the other 350 patients in the no-catheter group underwent extracorporeal shock wave lithotripsy directly. The satisfaction rate of X-ray display location, gravel effect, and rate of adverse reaction were compared. Results The satisfaction rate of X-ray display location in the catheter group was higher than the no-catheter group (P=0. 025). And the gravel effect of the two groups were of statistical significance (P=0. 041). The incidence of hematuria and lower urinary tract symptoms in the catheter group was significantly high-er than that in the no-catheter group (P<0. 05). The incidence of renal colic in catheter group was lower than that in no-catheter group (P=0. 001). Conclusion Indwelling double-J stents is useful for stones display and localization, and it can improve the stone clearance rate. For ureteral stones whose diameter were less than 1 cm, double-J stents has little influence on the rate of stone clearance, but it can reduce the occurrence of severe renal colic.
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Objective:To compare the clinical effects of Percutaneous nephrolithotomy lithotripsy (PCNL) and transurethral ureteroscopy (URL) in the treatment of impacted upper ureteral calculi.Methods:Since 2008, There were 144 cases with incarcerated upper ureteral calculi in hospital, all patients were divided into two groups according to the different ways of treatment, the PCNL group with 72 cases and the URL group with another 72 cases. Monitor and record the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation, average length of stay and total costs of the two groups. Through the Analysis to the data obtained, compare the clinical results of PCNL and URL in the treatment of impacted upper ureteral calculi.Results: For PCNL group, the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation was 95.8% (69/72), 93.1% (67/72) and 98.6% (71/72), while for URL group, the data was 84.7% (61/72), 83.3% (60/72) and 86.1% (62/72), the difference was statistically significant (x2=5.18,x2=5.85,x2=6.49;P<0.05); The operation time, average length of stay and total costs for PCNL group are greater than the URL group, and the difference was statistically significant(t=3.80, t=4.87,t=5.34;P<0.05).Conclusion: PCNL compared with the URL in the treatment of impacted upper ureteral calculi has a better performance on stone clearance, but there are problems of higher costs and longer hospital stay. Accordingly, patients need a comprehensive comparison and choose the appropriate way.
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Objective To compare the therapeutic effects of minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneal laparoscopic ureterolithotomy(RLUL) in the management of impacted upper ureteral calculi.Methods A total of 72 patients with unilateral impacted upper ureteral calculi were treated with MPCNL(n=45) or RLUL(n=27).The operation time,clearance rate of the stone,and the incidence of postoperative hyperpyrexia were statistically analyzed.Results All the operations were completed.As compared to the RLUL group,the MPCNL group had a significant shorter operation time [(43?9) minutes vs(69?17) minutes,t=-11.564,P=0.000].On the day after the operation,both the groups showed a stone clearance rate of 100%.No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [13.3%(6/45) vs 11.1%(3/27),?2=0.000,P=1.000).The patients were followed up for 1 to 24 months(mean,8 months),none of them developed ureteral stricture or recurrent stones during the period.Conclusion Both MPCNL and RLUL are safe,effective,and feasible for impacted upper ureteral calculi.
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PURPOSE: The aim of this study is to compare extracoporeal shock wave lithotripsy (ESWL) with ureteroscopic lithotripsy (URS) to establish the efficacy in treating upper ureteral calculi. MATERIALS AND METHODS: We retrospectively reviewed our experience with 279 patients treated with ESWL and URS for a upper ureteral calculi. Two hundred and four patients were treated with ESWL using MPL-9000 while 75 patients were treated with URS using 8/9.8Fr rigid ureteroscopes. Upper ureteral calculi were classified as those above L3 and below L4. We determined the comparative efficacies of ESWL with URS in the treatment of upper ureteral calculi according to location and size of stones. RESULTS: In the ESWL treatment, the overall stone free rate was 90.2%. The stone free rates were significantly affected by the location of the calculi with 92% above L3, and 84% below L4. The stone free rates according to the size were 91.9% for stones OR =21mm. Regardless of the size of the calculi, complete removal of all stone fragments was achieved in 86.7% of the patients treated with URS. The stone free rates according to the location of calculi were 79.2% in those above L3, and 90.1% in those below L4 with URS. ESWL has been found with a statistically significant higher success rate than URS in the treatment of above L3 ureteral calculi (p<0.05). On the other hand, URS showed a statistically significant higher success rate in the treatment of calculi larger than 21mm in size. The cost of URS was cheaper than ESWL but the complication rate was higher than ESWL. CONCLUSIONS: Our study demonstrates that the highly successful stone free rates can be achieved with either ESWL or URS. ESWL is useful as the first-line therapy for treatment of the upper ureteral calculi whereas URS should be considered as a treatment modality when the calculi are below L4 of the upper ureter and sizes of the calculi are larger than 21mm (URS).
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Humans , Calculi , Hand , Lithotripsy , Retrospective Studies , Shock , Ureter , Ureteral Calculi , UreteroscopesABSTRACT
PURPOSE: In situ SWL has become the preferred treatment modality for proximal ureteral calculi. However, reported rate of retreatment and need for stone manipulation such as stenting or push back were considerably high. We tried to determine the clinical factors affecting retreatment rate for effective in situ SWL. MATERIALS AND METHODS: One hundred seven patients with upper ureteral calculi underwent in situ SWL by using the Dornier MPL 9000 with ultrasound locating system. We evaluated the factors such as size and texture of the stone, degree of obstruction, distance from ureteropelvic junction and duration of symptom by comparing success rate of 1st session SWL. RESULTS: The overall stone free rate was 93.9% at 3 months. Average number of session of SWL was 1.35. Sucess rate of 1st session was 71%(76/107). Retreatment rate after 1st session was 29%(31/107). The significant clinical factors affecting retreatment rate of SWL were size of stones( 1.2cm), texture(rough shape) and complete ureteral obstruction. CONCLUSIONS: From these results we conclude that upper ureteral calculi with these factors should be performed primary in situ SWL more carefully to improved the therapeutic result.
Subject(s)
Humans , Lithotripsy , Retreatment , Shock , Stents , Ultrasonography , Ureter , Ureteral Calculi , Ureteral ObstructionABSTRACT
Extracorporeal shock wave lithotripsy (ESWL) was performed in 122 patients with upper ureteral calculi managed by 3 different techniques ; ESWL in situ. after push back and after placement of push back ureteral catheter below the stone in patients of failure to push back. To investigate the push back effect for upper ureteral stone, we reviewed 3 different treatment modalities. Of 122 patients push back was performed in 54 patients, which was successful in 27 patients (50%). The success rate of ESWL and the number of total average shock waves were 100%, 1667 waves in successful push back patients. 98.5%. 3007 waves in situ treatment and 88.9%, 4133 waves in patients of failure to push back. Complications of push back were infrequent, with the most common being ureteral perforation in 2 patients. all of which were managed conservatively. Push back of upper ureteral calculi improved success rate of ESWL and reduced significantly the number of average shock Waves.