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Objective To evaluate the application value of ultrasound-guided steel needle cross projection in percutaneous nephroscopy localization for clinical treatment. Methods From July 2015 to July 2017, we selected 307 cases of percutaneous nephrolithotomy with ultrasonic stereoscopic precision positioning, stones are antipyroid stones, renal calculi multiple kidney stones, ESWL treatment failure, isolated kidney stones, renal pelvis and ureteral junction (UPJ) obstruction with stones, open stone surgery recurrence, upper ureteral stones and so on. Refer to preoperative CT and KUB+IVP to determine the puncture angle and the puncture of the calyx. Then, in the ultrasonic stereo precise positioning to select the first mark line and the second mark line, two-line intersection for the final puncture point, this point with the first mark point connection with the vertical axis of the kidney.Finally, at the end of the puncture point in the ultrasonic stereo precise probe under the guidance of the probe to adjust the target angle of the calyx puncture. Results Of the 307 patients, 281 were 1 ~ 2 successful punctures, 21 were 3 ~ 5 times. The total success rate was 98.4% (302/307). 5 cases of small incision were separated to the kidney weeks under the guidance of the fingers.1 case of bleeding after 2 days (by selective renal artery embolization to stop bleeding).The net rate of calculi was 95.8% (294/307) and 13 residual stones were less than 0.5 cm. Conclusions The application of ultrasonic stereoscopic accurate positioning in percutaneous nephroscopy is safe and effective, and the localization method is refined and easy to be promoted.
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Objective To compare the clinical curative effect of partial tubeless and traditional percutaneous nephrolithotomy ( PCNL) in treatment of upper urinary calculus and to evaluate the clinical feasibility and value. Methods 206 patients with upper urinary calculus were enrolled in a randomized clinical trial from May 2013 to May 2014 according to the inclusion and exclusion criteria. These patients were randomized into the observation group (tubeless PCNL group) and the control group (traditional PCNL group). The operation time,stone clearance rate,visual analogue scale (VAS) pain score,usage of analgesic drugs,hemoglobin decrease,blood transfusion,bleeding,fever, leakage of urine,postoperative hospital stay,hospitalization expenses and the time of patients return to normal life were compared. Results All the operations were successfully finished. There were no statistically significant difference in operation time,stone clearance rate,hemoglo-bin decrease,bleeding,blood transfusion and fever (P>0. 05),but the visual analogue scale (VAS) pain score,usage of analgesic drugs, leakage of urine,postoperative hospital stay,hospitalization expenses and the time of patients return to normal life of the observation group were evidently lower than those of the control group (P<0. 05). Conclusion As partial tubeless PCNL have a great advantage on ease post-operative pain,shorten postoperative hospital stay,reduce hospitalization expenses and accelerate patients return to normal life,it is safe and effective for the treatment of upper urinary calculus,and it should be popularized and applied.
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Objective To summarize the experience of management of upper urinary tract calculi by Extracorporeal Shock Wave Lithotripsy (ESWL) in our department in order to improve the gravel success rate and decrease the incidence of complications.Methods 15 019 patients with upper urinary calculi from October 1988 to September 2011 treated by ESWL with X-ray localization were analyzed retrospectively.The maximum diameter of the stones ranged from 0.8 cm to 3.2 cm,with 1 3 794 cases with maximum stone diameter less than 2 cm (guoup A),and with 1225 cases with maximum stone diameter more than 2 cm (guoup B).All patients had normal or nearly normal renal function,and 56.0％ patients (8 410/15 019)had varying degrees of hydronephrosis.Results The effective rate of first ESWL was 84.5％ ( 12 691/15 019) and the effective rate of second ESWL was 12.0％ (1 802/15 019),and 313 cases need a third ESWL.The clearance rate in group A was 90.2％ ( 12 443/13 794 ),in group B was 50.9％ (623/1225),and the overall stone clearance rate within three months was 87.0％ ( 13 066/15 019).The majority of patients ( about 93％ ) had postoperative gross hematuria,which disappeared after drinking lots of water.46cases (0.3％) of patients had postoperative fever,which returned to normal after usage of antibiotics.There were no serious complications such as kidney hematoma,continuous high fever,continuous hematuria,ureteral stones jams.Conclusions ESWL.with X-ray localization had the advantage of low energy,minor injury,easy localization,uniform stone fragment,because of which it could reduce the complications such as continuity fever,ureter stone james,continuious hematuria.ESWL with X-ray localization could be preferred treatment for upper urinary calculi with diameters between 10 to 20 mm.
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443) ?mol/L) due to upper urinary calculous obstruction,urgently treated by pneumatic lithotripsy(EMS,Switzerland) under ureteroscopy,from August 2002 to April 2006 in this hospital.After stone fragmentation and removal,an indwelling double-J stent was placed into the ureter at the same time.Results The continuity of the ureter was restored after one session of lithotripsy in all the 9 cases(14 sides).The ureteral calculi were thoroughly removed on one session in 7 cases(12 sides).Few residual stones were found in the renal pelvis in 2 cases(2 sides),in one of which the stones were spontaneously expelled after oral medication,and in another,after extracorporeal shock wave lithotripsy(ESWL).No severe complications happened,such as ureteral avulsion,rupture,or perforation.Concentrations of serum creatine were decreased to normal levels within 3~7 days after operation in all the 9 cases.The gross blood urine disappeared in 1~4 days postoperatively.The patients were discharged from the hospital after 3~7 days (mean,5 days) after operation.The double-J catheter was removed at 1~2 months postoperatively.Follow-up examinations in 7 cases for 2~30 months(mean,14 months) found normal levels of serum creatine and no recurrent urinary stones under B-ultrasonography or X-ray radiography.Conclusions Ureteroscopic pneumatic lithotripsy in the treatment of acute renal failure due to upper urinary calculous obstruction is an effective treatment with short operation time,safety,and minimal trauma.By using this procedure,both sides of ureteral stones can be removed on one session.
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Objective To evaluate the efficacy and safety of percutaneous nephroscopic lithotripsy for the treatment of bilateral upper urinary calculi. Methods From July 2004 to December 2008,we performed percutaneous nephroscopic lithotripsy under X-ray or ultrasonic guidance for 35 patients with bilateral upper urinary calculi. Of the 35 patients,bilateral renal calculi were found in 18 patients,unilateral renal and unilateral ureteral calculus in 10,bilateral ureteral calculi in 7. Results In 35 patients (70 sides),the calculi was removed through a single tract in 49 sides,through double tracts in 18 sides,and through triple tracts in 3 sides. The mean operation time for unilateral PCNL was 66 min (ranged from 20 to 185 min). The stone-free rate was 80% (56/70) on one session. A second-look stone removal was needed in 8 laterals,and 3 laterals underwent three times of lithotomy. In three sides,a few residual renal stones were found after the first operation,but no second operation was performed. The final stone-free rate was 91.4% (64/70) in all of the cases,among which the stone-free rate was 100% (24/24) for ureteral stones and was 87% (40/46) for renal stones. In this series,no chest or abdominal injuries,intestinal perforation,or injuries to surrounding organs were detected. The patients were discharged from hospital in 5 to 30 days,and then were followed up for 3 to 6 months. During the follow-up,B-ultrasonography and KUB+IVP found no recurrence of calculi. Conclusions Percutaneous nephrolithotomy is effective and safe for bilateral upper urinary calculi. By skilled urologists in conditioned hospital,simultaneous bilateral percutaneous nephrolithotomy performed on bilateral upper urinary calculi can shorten the cycle time of treatment and hospitalization.