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【Objective】 To compare the efficacy and safety between partial tubeless and standard percutaneous nephrolithotomy in the treatment of upper urinary tract calculi. 【Methods】 The clinical data of 802 patients with upper urinary tract calculi treated at our hospital during Jun.2018 and Dec.2021 were retrospectively analyzed. The patients were divided into the partial tubeless group and standard group, and 60 cases in either group were selected by a simple random method. Clinical data, complications and stone-free rate were compared between the two groups. 【Results】 All 120 patients completed the operation successfully. The postoperative hospital stay, pain score and postoperative recovery of the partial tubeless group were significantly superior to those of the standard group (P0.05). 【Conclusion】 In the treatment of upper urinary tract calculi, partial tubeless percutaneous nephrolithotomy can achieve satisfactory surgical results, and has obvious advantages in postoperative recovery and patients’ experience. It is worthy of clinical application.
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【Objective】 To explore the efficacy of flexible ureteroscopic lithotripsy (FURL) under local anesthesia (LA) in the treatment of upper urinary tract calculi, and to analyze the risk factors of pain. 【Methods】 Clinical data of 255 patients treated during Apr.2022 and Sep.2022 were reviewed, including visual analogue score (VAS) of pain during ureteroscopy, sheath placement, holmium laser lithotripsy, 1 hour and 8 hours after operation. VAS ≥5 was defined as significant pain. Clinical and follow-up data of the significant pain group and non-significant pain group were analyzed with logistic regression to analyze the risk factors of pain in FURL under LA. 【Results】 Altogether 198 patients (77.6%) successfully completed the operation, and the stone-free rate (SFR) was 89.9% (178/198). The VAS of ureteroscopy was the highest (4.49±1.08), and 73 patients (28.6%) experienced significant pain. Univariate analysis showed that significant pain was associated with gender, previous surgical history, age, body mass index (BMI), education level, and ASA classification (P<0.05). Multivariate analysis showed that male (OR=2.896, 95%CI:1.413-5.933, P=0.040) and BMI≥28 (OR=7.776, 95%CI:2.268-26.657, P=0.001) were independent risk factors of significant pain, while age ≥65 years (OR=0.237, 95%CI:0.083-0.672, P=0.007) and previous surgical history (OR=0.156, 95%CI:0.032-0.754, P=0.021) were the protective factors. 【Conclusion】 It is feasible and effective to treat upper urinary tract calculi with FURL under LA. The presence of significant pain is associated with factors such as gender, age, BMI and previous surgical history.
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OBJECTIVE@#To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience.@*METHODS@#Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications.@*RESULTS@#A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=－2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=－2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=－0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=－0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ).@*CONCLUSION@#The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
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Adult , Female , Humans , Male , Middle Aged , Calcinosis/surgery , Endoscopy , Kidney Calculi , Nephrolithotomy, Percutaneous , Nephrostomy, Percutaneous , Retrospective Studies , Treatment Outcome , Urologic Diseases/surgeryABSTRACT
Objective: To estimate the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy in the treatment of upper urinary tract calculi in infants aged 3 years old and below. Methods: From January 2016 to March 2019, the cases of infants aged 3 years old and below who were treated with flexible ureteroscopy combined with holmium laser lithotripsy for upper urinary tract calculi in Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were collected. The double J (DJ) stents were placed in the cases for 0.5-3 months, followed by flexible ureteroscopy combined with holmium laser lithotripsy after urinary tract infection was controlled. OLYMPUS flexible ureteroscope and 200 μm holmium laser fiber were used in the operation. Holmium laser power was 20-30 Hz/0.5-1.0 J according to the size and hardness of the stones, and then DJ stent was retained after retraction of the ureteroscope to finish the operation. Results: A total of 32 infants aged 3 and below with upper urinary tract stones were included in the study, including 21 males and 11 females, and the median age was 26 months (7-36 months). All 32 cases were successfully treated with flexible ureteroscopy combined with holmium laser lithotripsy. Among them calculi in 22 cases were removed after one operation, and the calculi-free rate after one operation was 68.8%. The median duration of operation was 53 min (15-110 min); the median hospitalization after operation was 3 d (2-12 d); the median days of DJ stent removal after operation was 60 d (18-100 d). Urinary tract infection occurred in 4 cases, and high fever with urinary tract infection occurred in 2 cases. Anti-infection and other symptomatic treatments were given respectively to improve the symptoms. Conclusion: Flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe in the treatment of upper urinary tract calculi in infants, which can be widely used in clinic.
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Objective To analyze the effectiveness and the best drainage time of transurethral ureteral stent (D-J catheter) placement or percutaneous nephrostomy (PCN) in treating upper urinary tract calculi with infection at different time points after admission. Methods A total of 104 patients with upper urinary tract calculi and infection were enrolled in our hospital from Jan. 2018 to Dec. 2019. They were randomly divided into D-J catheter group and PCN group. According to the time from admission to operation, each group was then further divided into subgroups of ≤2 h, ＞2 h to 12 h and ＞12 h to 24 h (24, 18 and 10 cases, respectively). The body temperature, blood white blood cell (WBC) count and neutrophil proportion, C-reactive protein (CRP), serum procalcitonin, urine WBC count and the time of body temperature returning to normal were analyzed preoperatively and 1-3 d postoperatively. Results The patients in the two groups successfully received the operation with no change in operation mode. On the first day after the operation, the urine WBC counts were increased significantly in the three subgroups of each group (all P＜0.05). The body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were significantly higher in the three subgroups of the D-J catheter group than those in the three subgroups of the PCN group, while the urine WBC count was significantly lower (all P＜0.05). In the two groups, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and WBC count were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). On the second day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and urine WBC count were significantly lower in each subgroup of the PCN group than those in each subgroup of the D-J catheter group (all P＜0.05). On the third day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were basically decreased to normals, but the above indexes were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). The time of body temperature returning to normal was similar between the ≤2 h and ＞2 h to 12 h subgroups of the two groups (all P＞0.05), while the time in the ＞12 h to 24 h subgroup of the D-J catheter group was significantly longer than that of the PCN group (P＜0.05). Conclusion Transurethral D-J catheter placement and PCN drainage within 12 h after admission can achieve good efficacy in treating patients with upper urinary tract calculi and infection, and the infection control of PCN is better.
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Objective To investigate the intracavitary surgical therapy and efficacy for the patients with duplex kidney and ureter with upper urinary tract calculi. Methods The clinical data of twenty-six cases with duplex kidney and ureter with upper urinary tract calculi were retrospectively analyzed. Results Of 26 patients who underwent intracavitary surgical treatment, 5 patients were treated by ureteroscopic lithotripsy (URL), 15 by retrograde intrarenal surgery (RIRS), 6 by mini-percutaneous nephrolithotomy (mPCNL). All 26 cases were performed successfully. No severe complications such as septic shock, heavy blood loss, ureter injury, and pneumothorax occurred. 23 patients with nephrohydrosis were followed up for 2 to 24 months and most of them improved at different extents. Conclusion The current technique of intracavitary surgery in the management of duplex kidney and ureter concomitant with upper urinary tract calculi, has the advantages of less trauma, rapid recovery, safety and so on.
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Objective To investigate the clinical significance of monitoring the renal pelvic pressure( RPP) and regulating the manual perfusion pressure in flexible ureteroscope holmium laser lithotripsy. Methods A total of 189 patients with upper urinary tract calculi treated by RIRS in our hospital were retrospectively analyzed from August 2014 to August 2017. The renal pelvic pressure was monitored during RIRS in 136 cases( monitored group) whereas no monitoring occurred in the rest 53 cases( unmonitored group) . The monitored group was divided into two sub-groups of 49 cases named high-pressure group(the cumulative time of renal pelvis pressure upon 40 cmH2O≥1 min) and 87 ca-ses named low-pressure group respectively. The morbidity of postoperative fever ( T≥38. 5℃) was evaluated statistically between monitored group and unmonitored group,meanwhile between high-pressure group and low-pressure group. Results Postoperative fever did not correlate to age,sex,involved kidney,and postoperative urinary tract infection. Whether renal pelvic pressure was monitored or not,infection calculi, duration of operation and whether the cumulative time of renal pelvis pressure upon 40cmH2O≥1 min contributed to postoperative fever. The rate of postoperative fever in unmonitored group was higher than monitored group while the same between high-pressure group and low-pres-sure group,with statistically significant difference(P<0. 05). Conclusion Monitoring the intraoperative RRP and regulating the manual perfusion pressure during RIRS has positive significance in postoperative recovery and contribute to reducing postoperative fever.
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Objective To investigate the effect of early continuous renal replacement therapy on the prognosis of urinary sepsis after surgery for upper urinary tract calculi.Methods The clinical data of 59 patients with urinary sepsis after surgery for upper urinary tract calculi were retrospectively analyzed.In 59 patients with urinary sepsis,9 patients with early persistent renal replacement therapy were selected as the experimental group and 50 patients without early continuous renal replacement therapy as the control group. The age,sex ratio,diabetes,hypertension,the average operation time were no significant difference(P>0.05).Preoperative urinary tract infection,the experimental group preoperative urinary tract infection was significantly higher than the control group(77.8% vs.32.0%,P<0.05).In the results of preoperative urine culture positive ratio,the experimental group was also significantly higher than the control group,the difference was statistically significant(P<0.05).The changes of prognostic factors in patients with or without continuous renal replacement therapy were analyzed.Results In terms of the changes of postoperative laboratory results,the decrease of procalcitonin(PCT),C-reactive protein,white blood cell count and neutrophil ratio in the experimental group was significantly larger than that in the control group, and the difference was statistically significant;on the increase of hemoglobin,platelet count,fibrinogen,the standard bicarbonate level from blood gas analysis in the experimental group increased significantly more than the control group,the difference between the two groups were statistically significant.Conclusions Early renal replacement therapy in patients with urinary sepsis after upper urinary tract calculi surgeries can improve the prognosis of patients.
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Objective To investigate the efficacy and safety,as well as surgical essentials of upper urinary tract calculi (calculi being≤2 cm in diameter) complicated with pre-surgical uncertain pyonephrosis through one-stage renal calculi removal by percutaneous nephrolithotomy and suction device.Methods Retrospective analysis was used to detect the thirty-three cases with upper urinary tract calculi complicated with pre-surgical uncertain pyonephrosis collected from August 2010 to March 2016 in Yellow River Sanmenxia Hospital Affiliated to Henan University of Science and Technology,all the cases in the group had no pre-surgical fever,no apparent infection by blood-urine routine test,different degrees of hydronephrosis and no indications of pyonephrosis confirmed by CT and color Doppler ultrasonography,no pre-surgical anti-infection cure,pyonephrosis was found during the operation.First of all,a suction device was used to suck pus through percutaneous renal channel,rinsing repeatedly with small amount of fluid until the sucked rinsing fluid was clear;then,the one-stage calculi was removed by percutaneous renal lithotripsy,and the pus was sent to be cultured during the surgery,and the cases were treated by postoperative intravenous anti-infection for seven to seventeen days.Operation condition,postoperative blood routine,temperature,calculi removal and other clinical recovery conditions should be carefully observed.Results All the 33 cases underwent the one-stage single channel percutaneous nephrolithotom,the surgery was successful,the operation lasted 28-59 minutes,with an average of 41 minutes per case.Within the first-week of operation,CT reexamination showed the stone-free rate was 90.9% (30/33),and three cases had residual stone,the maximum diameter was about 6mm;seven cases had high fever within 3 days after the surgery (21.2%),and the temperature in four cases was higher than 38.5℃(12.1%) and two cases had fever within 3-6 days after surgery (6.1%),the highest temperature reached 38.0℃,and no fever existed after 6 days.Compared with preoperative values,the postoperative blood routine indicated that the surgery-relevant hemoglobin has decreased to (6.16±5.21) g/L;three days after surgery,white blood cell count was (7.16±4.86) 109/L.There were no severe complications such as sepsis,septic shock,renal abscess,hemorrhage.All cases were followed up for 6 to 36 months and no secondary pyonephrosis or renal dysfunction occurred during that period.Conclusion The treatment of upper urinary tract calculi,complicated with pyonephrosis without pre-surgical fever through one-stage renal calculi removal by percutaneous nephrolithotomy and suction device is effective and safe,it can be used as the routine method in basic hospitals and more attention should be paid to the operation and renal pelvic pressure in order to avoid the occurrence of complication.
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Objective To evaluate the efficacy and complications of flexible ureteroscopy for the treatment of upper urinary tract calculi in children.Methods The clinical data of upper urinary tract calculi in 20 children including 16 male and 4 female,treated by using flexible ureteroscopy,were collected from January 2014 to May 2015 in the First Affiliated Hospital of Zhengzhou University.The mean age was 6.4 years (ranging from 2.7-15.0 years old).Among them,6 cases had upper ureteral calculi and 14 cases had renal calculi.All the calculi was found unilaterally with on the left side in 12 cases and on the right side in 8 cases.Ipsilateral mild to moderate hydronephrosis were found in all of the cases.The mean stone size was 1.2 cm (ranging from 0.5-1.8 cm).All the cases were treated through retrograde flexible ureteroscopy holmium laser lithotripsy after the invalid conservative through conservative treatment.Double J tube was left routinely in the sick side 1 week before operation to expand the internal diameter of the ureter.A double J stent was left in place for 1 month after operation as a routine.Results The flexible ureteral access sheath failed to insert into the upper ureter in 2 cases because of the narrow ureter,then the flexible ureteroscopy was inserted into ureter through wire directly.The flexible ureteral access sheath was successfully inserted into the ureter for the others and flexible ureteroscopy were inserted through flexible sheath.The mean operative time was 38 min (ranging from 20-60 min).The patients were discharged from hospital after a mean of 4.5 days (ranging from 3-7 days).The rate of stone-free in one-stage was more than 90％.There were residual small stones in the lower calices of kidney in 2 cases.The perfusion liquid volume during the operation was 500 mL(ranging from 200-1 000 mL).There was no major perioperative complication,while transient macroscopic hematuria and fever were common complications after operation.The stone search was performed successfully in the whole 14 cases.NO residual stone could be found through ultrasound and kidney ureter bladder plain and Double-J stent was removed 1 month after operation.Conclusions Flexible ureteroscopy produces high stone-free rate and clinical safety for upper urinary calculi in children.However,the complications of flexible ureteroscopy lithotripsy cannot be ignored and sufficient preoperative preparation and careful perioperative safety control should be required.
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Objective:To study the curative effect of standard channel (percutaneous nephrolithotomy) PCNL combined with ultrasonic pneumatic lithotripsy in the treatment of upper urinary tract calculi under the guidance of ultrasound, and analyze the influence factors of post-operative residual calculi.Methods: The data of 94 patients with upper urinary tract calculi were researched by using retrospective analysis. All of patients underwent the treatment of standard channel PCNL combined with ultrasonic pneumatic lithotripsy for upper urinary tract calculi under the guidance of ultrasound. The curative effects of upper ureteral calculi, pelvis calculi, multiple renal calculi, kidney stone with ureteral calculi and renal staghorn calculi were observed, and the post-operative complications were further detected so as to grasp the situation of residual calculi and calculate the clearance rate of calculus. The difference of general documents between patients with residual calculi and those without residual calculi were compared, and the influence factors of residual calculi were analyzed by using Logistic regression equation.Results:The incidence of post-operative complication was 27.66%, the clearance rate of calculus was 67.2% and residual rate of calculus was 32.98%. The differences of location puncture time, establishing channel time and ostomy fistula time among the five kinds of patients were no significant (F=1.89,F=2.46, F=0.91,P>0.05). While the differences of calculus removed time, amount of bleeding in intra-operative period and length of stay among various kinds of patients were significant (F=81.90,F=35.84,F=4.17,P<0.05). Depended on the results of Logistic regression equation, the types of calculus, size of calculus, hydronephrosis, urinary tract infection and renal insufficiency were the influence factors of post-operative residual calculus of patients with upper urinary tract calculi who received the treatment of PCNL combined with ultrasonic pneumatic lithotripsy.Conclusion: PCNL combined with ultrasound pneumatic lithotripsy under the guidance of B ultrasound without major complications has better curative effect, and its clearance rate of calculus is higher. Besides, the types of calculus, size of calculus, hydronephrosis, urinary tract infection and renal insufficiency can increase the incidence of post-operative residual calculus and affect the curative effect.
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Objective To investigate the changes of microRNA-223 (miR-223) in patients with complication of sepsis after mini-invasive surgery of upper urinary tract stones, and to approach the value of miR-223 in the early diagnosis of sepsis. Methods Patients with upper urinary tract stones underwent micro-invasive treatment in the Department of Urology Surgery of the Affiliated Hospital of Hangzhou Normal University from January 2014 to January 2017 were enrolled. There were 60 patients with sepsis within 24 hours after surgery were assigned in the sepsis group, and 60 patients without sepsis were included in the non-sepsis group. The clinical data of miR-223, CD4+CD25+regulatory T cells (CD4+CD25+ Treg), procalcitonin (PCT) interleukin-10 (IL-10), tumor necrosis factor-α(TNF-α), C-reactive protein (CRP) in the blood, etc were collected within 24 hours after surgery. The differences in above indexes were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn to evaluate the diagnostic values of blood mir-223, PCT and CRP in the patients, predicting whether septic complication after urinary calculi surgery would occur. Correlation analyses were used to analyze the correlations between mir-223 and CD4+CD25+ Treg, IL-10 and TNF-α. Results The miR-223 expression level and the contents of CD4+CD25+ Treg, IL-10, TNF-α, PCT and CRP in sepsis group were obviously higher than those in non-sepsis group [2ΔΔCt (×10-4):2.81±1.04 vs. 2.13±0.91, CD4+CD25+ Treg(×10-2): 17.61±4.48 vs. 8.37±2.71, IL-10 (ng/L): 58.42±16.38 vs. 34.68±12.45, TNF-α (pg/L): 249.41±30.69 vs. 167.54±25.98, PCT (ng/L): 4.45±1.89 vs. 0.31±0.08, CRP (μg/L):10.29±3.63 vs. 4.13±1.57, all P < 0.05); in sepsis group, the miR-223 expression and the level of CD4+CD25+ Treg (r = 0.367, P = 0.004) and IL-10 (r = 0.516, P = 0.006) were also significantly positively correlated, but miR-223 and TNF-α were not markedly correlated (r = 0.237, P > 0.05). The area under ROC curve (AUC), sensitivity, specificity and 95% confidence interval (95%CI) of miR-223 predicting sepsis occurrence after urinary operation were higher than those of CRP, PCT (AUC: 0.923 vs. 0.547, 0.769, the sensitivity: 81.73% vs. 71.23%, 66.59%, specificity: 86.00%vs. 42.00%, 83.00%, 95%CI: 0.862-0.979 vs. 0.351-0.679, 0.682-0.927). Conclusions The expression levels of plasma miR-223 in patients with sepsis after mini-invasive treatment for upper urinary tract lithotrity can reflect their immune reaction status, and can be one of the early diagnostic markers of whether the sepsis complication may occur after the surgery.
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Objective To investigate the changes of microRNA-223 (miR-223) in patients with complication of sepsis after mini-invasive surgery of upper urinary tract stones, and to approach the value of miR-223 in the early diagnosis of sepsis. Methods Patients with upper urinary tract stones underwent micro-invasive treatment in the Department of Urology Surgery of the Affiliated Hospital of Hangzhou Normal University from January 2014 to January 2017 were enrolled. There were 60 patients with sepsis within 24 hours after surgery were assigned in the sepsis group, and 60 patients without sepsis were included in the non-sepsis group. The clinical data of miR-223, CD4+CD25+regulatory T cells (CD4+CD25+ Treg), procalcitonin (PCT) interleukin-10 (IL-10), tumor necrosis factor-α(TNF-α), C-reactive protein (CRP) in the blood, etc were collected within 24 hours after surgery. The differences in above indexes were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn to evaluate the diagnostic values of blood mir-223, PCT and CRP in the patients, predicting whether septic complication after urinary calculi surgery would occur. Correlation analyses were used to analyze the correlations between mir-223 and CD4+CD25+ Treg, IL-10 and TNF-α. Results The miR-223 expression level and the contents of CD4+CD25+ Treg, IL-10, TNF-α, PCT and CRP in sepsis group were obviously higher than those in non-sepsis group [2ΔΔCt (×10-4):2.81±1.04 vs. 2.13±0.91, CD4+CD25+ Treg(×10-2): 17.61±4.48 vs. 8.37±2.71, IL-10 (ng/L): 58.42±16.38 vs. 34.68±12.45, TNF-α (pg/L): 249.41±30.69 vs. 167.54±25.98, PCT (ng/L): 4.45±1.89 vs. 0.31±0.08, CRP (μg/L):10.29±3.63 vs. 4.13±1.57, all P < 0.05); in sepsis group, the miR-223 expression and the level of CD4+CD25+ Treg (r = 0.367, P = 0.004) and IL-10 (r = 0.516, P = 0.006) were also significantly positively correlated, but miR-223 and TNF-α were not markedly correlated (r = 0.237, P > 0.05). The area under ROC curve (AUC), sensitivity, specificity and 95% confidence interval (95%CI) of miR-223 predicting sepsis occurrence after urinary operation were higher than those of CRP, PCT (AUC: 0.923 vs. 0.547, 0.769, the sensitivity: 81.73% vs. 71.23%, 66.59%, specificity: 86.00%vs. 42.00%, 83.00%, 95%CI: 0.862-0.979 vs. 0.351-0.679, 0.682-0.927). Conclusions The expression levels of plasma miR-223 in patients with sepsis after mini-invasive treatment for upper urinary tract lithotrity can reflect their immune reaction status, and can be one of the early diagnostic markers of whether the sepsis complication may occur after the surgery.
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Objective To evaluate the reasonable individual program for upper urinary tract calculi in minimally invasive treatment. Methods From January 2013 to June 2016, 147 patients (sides) with upper urinary calculi who had some characteristics received laparoscopic nehprectomy or corresponding surgical treatment. The number of cases of postoperative stagnation, the average hospitalization time and the average cost of treatment were compared with those of 147 patients (lateral) who underwent PCNL and URSL with the similarity, shape and load of stones before June 2016, respectively. Results The removal rate of stage I was 100.00％ (147/147) in laparoscopic group, which was significantly higher than that in PCNL and URSL group (91.84％, 135/147), the difference was statistically significant (P = 0.001); Laparoscopic group postoperative blood transfusion (0/147) and interventional hemostasis (0/147) were significantly lower in 6 cases (6/147) and 4 cases (4/147) in PCNL and URSL groups,the differences were statistically significant (P = 0.013, P = 0.044). There was no postoperative severe infection in laparoscopic group (0/147), which has no significant difference (P = 0.156) in postoperative severe infection between PCNL and URSL group (2/147). There were 9 cases of 134 cases of postoperative (9/134) fever at ≥ 38℃ in laparoscopic group, which was significantly lower than that in PCNL and URSL group (28/147), the difference was statistically significant (P = 0.002); Laparoscopic group of postoperative urinary tract stenosis in 3 cases (3/114), which was significantly lower than that of PCNL and URSL group (9/101), the difference was statistically significant (P = 0.045). The average length of stay in laparoscopic group was (10.12 ± 0.29) d, which was significantly lower (P = 0.011) than that in PCNL and URSL group (13.97 ± 0.38) days. The average cost of treatment in laparoscopic group (12541.84 ± 181.54) yuan was significantly lower than that in PCNL and URSL group (18124.65 ± 302.32) yuan, the difference was statistically significant (P = 0.018). Conclusion In some cases, when the upper urinary tract calcuci are suitable for 'cut out', the use of laparoscopic treatment is more secure; when there is a need for surgical treatment of complications, can be treated simultaneously. Laparoscopic technique is one of the important methods of minimally invasive treatment for upper urinary calculi.
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Objective To discuss the risk factor of infection after intracavity lithotripsy in upper urinary tract calculi,and establish a pre-operation warming score system.Methods From Jan.2013 to May 2016,412 upper urinary calculi patients who underwent intracavity lithotripsy were analyzed to evaluate the associated risk factors before operation and infection after operationg by non-conditional logistic regression analysis.The pre-operation warming score system was established by giving those risk factor 1-4 point based on OR value.The best threshold was then determined by ROC curve.Results Diabetes mellitus,infection history,renal calculus and uretero-pelvic junction calculus,stone burden,the degree of hydronephrosis and the gender of female were high-risk factors contributed to infection after intracavity lithotripsy,which were given 3,3,3,2,2,2point respectively based on their OR value(8.660,7.046,3.723,2.675,2.256,1.891),and the patients who got high socre were more likely to suffered infection.The sensitivity and specificity of the wanning score system for infection after intracavity lithotripsy were 74.3％ and 84.0％ respectively when its truncation point was 7.5 point(total score was 15 piont).Conclusions Patients who got more than 7.5 point according to the wanning score system were high risk groups of infection after intracavity lithotripsy.
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Objective:To analyze the diagnostic value of colour Doppler ultrasonography and X-ray plain film radiography in upper urinary tract calculi.Methods: 97 cases of upper urinary tract calculi were randomly selected in our hospital between 2012 January and 2013 January, who were examined by colour Doppler ultrasound and X-ray film and then the results were analysed and compared.Results: In the 97 cases with colour Doppler ultrasound, 92 cases were the positive renal calculi, and the effective diagnosis rate was 94.8%. And then in the 97 cases with X-ray film, 67 cases were the positive renal calculi, and the effective diagnosis rate was 69.1%. The positive diagnosis rate in the group with colour Doppler ultrasound was higher than that in the group with X-ray film (x2=16.34,P<0.05). In the 97 cases with colour Doppler ultrasound, 52 cases were the positive ureteral calculi, and the effective diagnosis rate is 53.6%. And then in the 97 cases with X-ray film, 69 cases were the positive ureteral calculi and the effective diagnosis rate was 71.1%. The positive diagnosis rate in X-ray film group was higher than that in the group with colour Doppler ultrasound (x2=10.65, P<0.05).Conclusion: In diagnosis of upper urinary tract calculi, the diagnosis rate of renal calculi is higher by colour Doppler ultrasound and the diagnosis rate of ureteral calculi is higher by X-ray film. Both methods have advantages and disadvantages in inspection, and we should combine them in clinical practice.
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Objective To explore the gender differences in patients with primary hyperparathyroidism (PHPT) concurrent with upper urinary tract stone.Methods The clinical data of 40 PHPT concurrent with upper urinary tract stone cases treated from January 1997 to December 2013 were analyzed retrospectively.There were 21 males and 19 females,with an mean age of 51 years (26-77 years).All patients underwent operation for PHPT,with preoperative parathyroid hormone (PTH) level of (38.42± 30.11)pmol/L.The PTH level in female patients was significantly higher than that in male patients (29.37± 17.64pmol/L versus 48.47±40.55 pmol/L,P=0.04).Serum biochemical variables were monitored,and 21 cases had 24 h-urinalysis.Results Postoperative pathology confirmed 36 cases of parathyroid adenoma and 4cases of parathyroid hyperplasia.Hypercalcemia and hypophosphatemia were improved with no significant gender difference (both P＞0.05).But in 21 cases of 24 h-urinalysis,urinary calcium and phosphorus in males were significantly higher than those in females (8.26±2.60 mmol/24 h versus 6.08± 1.59 mmol/24 h,P=0.03; 7.03±1.44 mmol/24 h versus 5.42±1.25 mmol/24 h,P=0.01).Conclusion In patients with PHPT concurrent with urolithiasis,male patients may be more associated with hypercalciuria.
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Objective To explore the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for pediatric upper urinary tract calculi. Methods We retrospectively reviewed the clinical data of 35 pediatric patients with upper urinary tract stones treated by MPCNL in our hospital. The series consists of 29 boys and 6 girls with a mean age of 8.5 years (4 to 13 years). Among the 35 cases,7 children had proximal ureteral stones and 28 showed renal stones; 2 of the patients were complicated with ureteropelvic junction obstruction (UPJ). Results Totally 31 (88.6%) of the 35 cases were cured by MPCNL. The one-session success rate was 87.1% (27/31),and two-session success rate was 75% (3/4). Four patients were converted to open surgery because of UPJ-caused ureteral stenosis under the level of the calculi or failure in percutaneous renal puncture. Conclusion MPCNL is safe and effective for renal calculi and proximal ureteral calculi in children.
ABSTRACT
Extracorporeal shock wave lithotripsy (ESWL) has proved to be an effective method of treating upper urinary tract calculi in adults. But the application of ESWL in children was less clearly defined. We report on 28 pediatric patients who were treated by ESWL with the Northgate SD-3 lithotriptor between June, 1989 and May, 1994. The patient age ranged from 2 years to 17 years, with an average age of 11.1 years. The conditions known to be associated with stone formation were urinary tract infection in 6 patients (21.4%), vesicoureteral reflux in 1 patient (3.6%) and unknown in other patients. The total average success rate of treatment was 92.9%. ESWL complications required admission and surgical management were not observed. We concluded that ESWL with the Northgate SD-3 lithotriptor is a safe and effective method of treating upper urinary tract calculi in children.