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【Objective】 To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter. 【Methods】 A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group (n=45) and ordinary group (n=40). The operation time, complications, infection indexes 2 h after operation, adverse reactions, treatment efficacy and stone-clearance rate were compared between the two groups. 【Results】 The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups. The negative pressure group had significantly shorter operation time than the ordinary group [(43.3±4.9) min vs. (66.2±5.8) min, P0.05). The increase of infection indexes (procalcitonin and leukocyte) 2 h after operation were significantly lower in the negative pressure group than in the ordinary group (P<0.05). The efficacy in the negative pressure group was 91.11% (41/45) and the stone-clearance rate was 95.56% (43/45), which were significantly better than those in the ordinary group (72.50% (29/40) and 80% (32/40), respectively. The total incidence of adverse reactions such as renal colic, gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group (P<0.05). 【Conclusions】 Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective, as the circulation perfusion keeps the operation field clear, reduces the operation time and improves the stone-clearance rate, while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.
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Ureteroscopy plays an important role in the diagnosis and treatment of upper tract urothelial carcinoma (UTUC). Conventional ureteroscopy (URS) can not only identify the location, appearance and size of a tumor, but also assess tumor grade by biopsy. The continued development of electronic flexible ureteroscopy and assistive technologies has led to further advances in the diagnosis of UTUC. Ureteroscopic laser ablation can be used to treat low grade malignancy, renal insufficiency, or isolated kidney. However, the use of URS may have potential risks such as delay of radical treatment, increased surgical difficulty, intraoperative or postoperative complications and intravesical recurrence. This article reviews the advantages and disadvantages of ureteroscopy in the diagnosis and treatment of UTUC.
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【Objective】 To evaluate the efficacy and safety of 3-dimensional laparoscopic pyeloplasty and ultrasound-guided flexible ureteroscopy lithotripsy (3DLP-UGFURL) in the treatment of ureteropelvic junction obstruction (UPJO) and renal calculi. 【Methods】 The clinical data of 29 patients of UPJO complicated with renal calculi treated with 3DLP-UGFURL during Dec.2017 and Jul.2022 were retrospectively analyzed. There were 23 males and 6 females with average age of (35.3±13.6) years. The lesions were on the left side in 20 cases, on the right side in 9 cases, and all were unilateral. One case was complicated with horseshoe kidney. The body mass index (BMI) was 23.6±3.9. Multiple calculi of renal pelvis or calyces occurred in 16 cases, and the rest were single calculi. The maximum diameter of calculi was (1.2±0.6)cm. There were 2 cases of mild hydronephrosis, 19 cases of moderate hydronephrosis and 8 cases of severe hydronephrosis. 【Results】 All operations were successful. The operation time of 3DLP was (84.2±15.4)min. Operation time of UGFURL was (42.8±15.7)min. Estimated blood loss was (36.9±13.6)mL. Indwelling time of drainage tube was (3.6±1.6)d. Indwelling time of urinary catheter and postoperative hospital stay was (6.8±1.2)d. One month after operation, the stone removal rate was 97.4%. The retention time of ureteral stent was 2.7 months. During the follow-up of (24.5±10.0)months, there were 45 Clavien Dindo grade 1 complications. 【Conclusion】 3DLP-UGFURL is safe and effective in the treatment of UPJO complicated with renal calculi, but it still needs long-term follow-up data.
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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 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 compare the safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by retrograde flexible ureteroscopy.@*METHODS@#A total of 90 patients with 1-2 cm upper ureteral calculi treated in the urology department of Beijing Friendship Hospital from August 2018 to August 2020 were selected as the subjects. The patients were divided into two groups using random number table: 45 patients in group A were treated with in situ lithotripsy and 45 patients in group B were treated with active migration technique. The active migration technique was to reposition the stones in the renal calyces convenient for lithotripsy with the help of body position change, water flow scouring, laser impact or basket displacement, and then conduct laser lithotripsy and stone extraction. The data of the patients before and after operation were collected and statistically analyzed.@*RESULTS@#The age of the patients in group A was (51.6±14.1) years, including 34 males and 11 females. The stone diameter was (1.48±0.24) cm, and the stone density was (897.8±175.9) Hu. The stones were located on the left in 26 cases and on the right in 19 cases. There were 8 cases with no hydronephrosis, 20 cases with grade Ⅰ hydronephrosis, 11 cases with grade Ⅱ hydronephrosis, and 6 cases with grade Ⅲ hydronephrosis. The age of the patients in group B was (51.8±13.7) years, including 30 males and 15 females. The stone diameter was (1.52±0.22) cm, and the stone density was (964.6±214.2) Hu. The stones were located on the left in 22 cases and on the right in 23 cases. There were 10 cases with no hydronephrosis, 23 cases with grade Ⅰ hydronephrosis, 8 cases with grade Ⅱ hydronephrosis, and 4 cases with grade Ⅲ hydronephrosis. There was no significant diffe-rence in general parameters and stone indexes between the two groups. The operation time of group A was (67.1±16.9) min and the lithotripsy time was (38.0±13.2) min. The operation time of group B was (72.2±14.8) min and the lithotripsy time was (40.6±12.6) min. There was no significant difference between the two groups. Four weeks after operation, the stone-free rate in group A was 86.7%, and in group B was 97.8%. There was no significant difference between the two groups. In terms of complications, 25 cases of hematuria, 16 cases of pain, 10 cases of bladder spasm and 4 cases of mild fever occurred in group A. There were 22 cases of hematuria, 13 cases of pain, 12 cases of bladder spasm and 2 cases of mild fever in group B. There was no significant difference between the two groups.@*CONCLUSION@#Active migration technique is safe and effective in the treatment of 1-2 cm upper ureteral calculi.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Ureteral Calculi/surgery , Hematuria/therapy , Ureteroscopy/methods , Lithotripsy/methods , Lithotripsy, Laser/methods , Hydronephrosis/complications , Pain , Treatment Outcome , Retrospective StudiesABSTRACT
The clinical data of 120 patients admitted to our hospital with renal stones treated by flexible ureteroscopy (FURS) and the imaging-related data measured by virtual reality technology were retrospectively analysed. The results of the univariate analysis showed that stone surface area (S), renal pelvis volume (P), length of calyces funnel (L), pelvic calyceal height (H) and essence of stone (E) were closely related to stone-free rate. The H. L.P.E.S. score was constructed to predict stone-free rate after FURS based on the above factors, and the area under the receiver aperating characteristic curve for the H. L.P.E.S. and S. O.L.V.E. scoring systems was 0.921 and 0.754 respectively.The H. L.P.E.S. scoring system has higher predictive value.
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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 evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9％,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6％ (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P ＜ 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P ＜ 0.05) and position (x2 =44.949,P ＜ 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.
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@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION: The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.
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Ureteroscopy , Ureteroscopes , Printing, Three-DimensionalABSTRACT
@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications.@*OBJECTIVE@#To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy.@*METHODS@#This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale.@*RESULTS@#The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%).@*CONCLUSION@#The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.
Subject(s)
Ureteroscopy , Ureteroscopes , Printing, Three-DimensionalABSTRACT
Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective@#To evaluate the clinical efficacy of percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy in the treatment of complicated renal calculi.@*Methods@#Clinical data of 139 patients with complicated renal calculi from March 2013 to March 2019 in Miyun Teaching Hospital, Capital Medical University were retrospectively analyzed. There were 76 males and 63 females, the average was (47.9±3.1) years, aged from 27 to 75 years. The total patients were divided into control group (n=69) and treatment group (n=70) according to different treatment method. The patients in the control group treated with percutaneous nephrolithotorny, the patients in the treatment group were treated with flexible ureteroscopy and holmium laser lithotripsy on the bassis of the control group. Compared the operation time, hospital stays, intraoperative blood loss, effective rate and complication incidence rate between two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data was compared by Chi-square test.@*Results@#In the control group, the operation time, length of hospital stay and intraoperative blood loss were (65.85±3.83) min and (8.83±4.00) d, (130.72±1.20) ml, respectively, the treatment group were (43.44±3.16) min, (5.72±1.07) d, (96.21±0.98) ml, respectively, the difference between group there was statistical significance (P<0.05); the total effective rate of the control group was 84.0% (58/69), which was significantly lower than that of the treatment group [95.7% (67/70)], and the difference between the groups was statistically significant (P<0.05). The incidence of postoperative complications of the treatment group[2.8% (2/70)] was significantly lower than the control group[14.5% (10/69)], and the difference between the two groups was statistically significant (P<0.05).@*Conclusion@#The complicated renal calculi by percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy has the advantage of short operation time, less blood loss, faster recovery and low complication incidence rates, has clinical use and promotion value.
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Objective@#To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.@*Methods@#A total 96 patients from June 2016 to June 2018 were analyzed retrospectively. It included 53 males and 43 females, aged 21 to 57(average 41) years old. All patients were diagnosed with kidney stones by KUB, IVU and CT examination. 19 cases of bilateral kidney stones and 37cases in left and 40 cases in right. 67 cases of single stones and 29 cases of multiple. There were 34 cases of renal pelvis calculi, 19 cases of meddle calyx, 17 cases of superior calyx and 26 cases of inferior calyx. Maximum diameter of calculus was 0.8-2.9 cm, average(1.6±0.8)cm, of which 49 cases size were over 2 cm. There is no obvious stenosis of the renal pelvis and ureter. There were 29 cases of CD4+ lymphocyte count ≤400/μl, and 26 cases of preoperative ureteral stents. Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy. 46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection, and prophylactic antibiotics, 51 cases without antibiotics. All 96 cases underwent lithotripsy and record postoperative conditions. Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.@*Results@#All 96 cases were successfully completed, no open surgery, no complications. The operation time was 40-130 min (average 57 min), of which 34 cases were over 60 min. Postoperative retained catheter time was 2 to 11 days (average 3.5 days), of which 27 cases were over 7 days. Urinary tract infection occurred in 18 of all patients, with an incidence of 18.8%. The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection, 3 cases of Proteobacteria infection, and 2 cases of fecal cocci infection. There were 14 cases of calculi size over 2 cm, 10 cases of CD4+ lymphocyte count≤400/μl, 11 cases of preoperative ureteral stents, 3 cases of prophylactic antibiotics, 11 cases of operation time over 60 min, and 10 cases of postoperative retained catheter over 7 days. Single factor analysis found that CD4+ lymphocyte count≤400/μl, preoperative ureteral stents, larger calculi size, longer operation time, postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P<0.05), Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P<0.05). Multivariate logistic regression analysis suggested that CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 days, and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P<0.05).@*Conclusions@#CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 d, and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
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Objective To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.Methods A total 96 patients from June 2016 to June 2018 were analyzed retrospectively.It included 53 males and 43 females,aged 21 to 57(average 41) years old.All patients were diagnosed with kidney stones by KUB,IVU and CT examination.19 cases of bilateral kidney stones and 37cases in left and 40 cases in right.67 cases of single stones and 29 cases of multiple.There were 34 cases of renal pelvis calculi,19 cases of meddle calyx,17 cases of superior calyx and 26 cases of inferior calyx.Maximum diameter of calculus was 0.8-2.9 cm,average (1.6 ± 0.8) cm,of which 49 cases size were over 2 cm.There is no obvious stenosis of the renal pelvis and ureter.There were 29 cases of CD4 + lymphocyte count ≤400/μl,and 26 cases of preoperative ureteral stents.Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy.46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection,and prophylactic antibiotics,51 cases without antibiotics.All 96 cases underwent lithotripsy and record postoperative conditions.Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.Results All 96 cases were successfully completed,no open surgery,no complications.The operation time was 40-130 min (average 57 min),of which 34 cases were over 60 min.Postoperative retained catheter time was 2 to 11 days (average 3.5 days),of which 27 cases were over 7 days.Urinary tract infection occurred in 18 of all patients,with an incidence of 18.8％.The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection,3 cases of Proteobacteria infection,and 2 cases of fecal cocci infection.There were 14 cases of calculi size over 2 cm,10 cases of CD4+ lymphocyte count ≤ 400/μ l,11 cases of preoperative ureteral stents,3 cases of prophylactic antibiotics,11 cases of operation time over 60 min,and 10 cases of postoperative retained catheter over 7 days.Single factor analysis found that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,larger calculi size,longer operation time,postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P ＜ 0.05),Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P ＜ 0.05).Multivariate logistic regression analysis suggested that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 days,and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P ＜ 0.05).Conclusions CD4 + lymphocyte count ≤ 400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 d,and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
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Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy in the treatment of complicated renal calculi.Methods Clinical data of 139 patients with complicated renal calculi from March 2013 to March 2019 in Miyun Teaching Hospital,Capital Medical University were retrospectively analyzed.There were 76 males and 63 females,the average was (47.9 ±3.1) years,aged from 27 to 75 years.The total patients were divided into control group (n =69) and treatment group (n =70) according to different treatment method.The patients in the control group treated with percntaneous nephrolithotorny,the patients in the treatment group were treated with flexible ureteroscopy and holmium laser lithotripsy on the bassis of the control group.Compared the operation time,hospital stays,intraoperative blood loss,effective rate and complication incidence rate between two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data was compared by Chi-square test.Results In the control group,the operation time,length of hospital stay and intraoperative blood loss were (65.85 ± 3.83) min and (8.83 ± 4.00) d,(130.72 ± 1.20) ml,respectively,the treatment group were (43.44 ± 3.16) min,(5.72 ± 1.07) d,(96.21 ± 0.98) ml,respectively,the difference between group there was statistical significance (P ＜ 0.05);the total effective rate of the control group was 84.0％ (58/69),which was significantly lower than that of the treatment group [95.7％ (67/70)],and the difference between the groups was statistically significant (P ＜ 0.05).The incidence of postoperative complications of the treatment group[2.8％ (2/70)] was significantly lower than the control group[14.5％ (10/69)],and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusion The complicated renal calculi by percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy has the advantage of short operation time,less blood loss,faster recovery and low complication incidence rates,has clinical use and promotion value.
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Objective To establish S.O.L.V.E.nephrolithometry scoring system,and to evaluate value of S.O.L.V.E.scoring system for predicting the stone-free rate (SFR) of flexible ureteroscopy (FURS).Methods Five reproducible variables were included in S.O.L.V.E.scoring system,such as stone surface area (S),obstruction (O),length of calyces funnel (L),visible number of calyces (V) and essence of stone (E).Variables were measured based on preoperative non-contrast computed tomography of urography.Clinical data of 392 patients who underwent FURS for upper urinary tract stones in our department from January,2017 to Jnne,2018 were retrospectively analyzed.The total study population consisted of 258 male and 134 female patients.The mean age was (49.5 ± 12.6) years old,ranged from 15 to 85 years.There were 292 patients in stone-fiee group,including 197 male and 95 female patients.The average age was (49.2 ± 12.8) years old.37 patients had previous history of renal stone surgery.Median body mass index was 24.7 kg/m2 (18.1-29.0 kg/m2) and median value of preoperative serum creatinine was 72.5 μmol/L (48.9-84.8 μmol/L).The number of patients,whose stone located in the left side and right side were 155 and 137,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 19,16,87,170,respectively.There were 100 patients in non-stone free group,61 men and 39 women.The average age was (50.4 ± 12.0) years old.15 patients had previous history of renal stone surgery.Median body mass index was 25.0 kg/m2 (18.5-28.8 kg/m2) and median value of preoperative serum creatinine was 73.8 μmol/L (46.5-92.5 μnol/L).The number of patients,whose stone located in the left side and right side were 51 and 49,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 7,4,27,62,respectively.The correlation of S.O.L.V.E.scoring system and stone-free rate,postoperative hospital stay,surgical complications,operation time were analyzed.Receiver operating characteristic curves were drawn to detect predictive value of S.O.L.V.E.scoring system for SFR of FURS.Results All cases FURS were performed successfully and the SFR was 74.5％ (292/392).Among the variables of the S.O.L.V.E.scoring system in the stone-free group and the non-stone free group,item S were (82.6 ± 69.8) mm2 and (172.6±133.7)mm2,respectively.The item L were (12.7 ± 15.8) mm and (23.9 ± 15.3)mm,respectively.The item V were (0.6 ± 0.7) and (1.3 ± 0.8),respectively.The item E were (817.1 ± 285.5) HU and (902.4 ± 256.1) HU,respectively.The difference was statistically significant (P ＜ 0.01).The item O was (17.7 ± 10.9) mm and (19.3 ± 13.1) mm,respectively,no statistical significance was found (P =0.242).The mean score was 6.3 (ranging 4-11) in this c ohort.The patients were divided into low score (4-5) group,moderate score (6-8) group and high score (9-11) group due to S.O.L.V.E.scoring system,and the stone-free rates were 93.5％ (130/139),70.5％ (153/217) and 37.5％ (9/36),respectively (P ＜0.01).The operation time of low,moderate,andi high score group were (31.6 ± 10.9),(42.3 ± 18.3),and (58.0 ± 19.2) min,respectively.Additionally,the score was correlated with the operation time(P ＜0.01),but not with postoperative hospital stay (P =0.133),intraoperative bleeding (P =0.185) and postoperative infectious fever (P =0.839).In logistic regression model analysis,the stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR (P ＜ 0.01).The obstruction degree and essence of stone were not associated with SFR (P ＞ 0.05).The area under receiver operating characteristic curve of S.O.L.V.E.score was 0.782,higher than that of each variable in S.O.L.V.E.scoring system(S,O,L,V,E were 0.738,0.535,0.698,0.735,0.593,respectively).Conclusions The stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR.The S.O.L.V.E.nephrolithometry scoring system can predict SFR after FURS accurately,and provide assistance for making clinical decisions.
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Objective To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS)and minimally invasive percutaneous nephrolithotripsy (MPCNL)for the pediatric renal calculi (≥ 1.5 cm).Methods In the retrospective study,97 patients with renal calculi (≥ 1.5 cm) underwent operation which is conducted by the same operative team from March 2011 to March 2016.Among them,40 patients were treated with RIRS,including 29 male and 11 female patients.57 patients were treated with minimally invasive percutaneous nephrolithotripsy,including 45 males and 12 female patients.The mean stone size was (1.9 ± 0.4) cm (ranging 1.5-3.0 cm) in the RIRS group and (2.1 ± 0.5) cm(ranging 1.5-3.5 cm) in the MPCNL group.In RIRS group,3 stones were stag-horn calculi.The diameter in 44 stones was more than 1.5 cm.Among them,33 stones located in the renal pelvis and upper middle calyces.11 stones located in the lower calyces.Multiple stones were found in 30 cases and single stone was found in 10 cases.7 cases had the history of unilateral urolithiasis.3 cases had the positive results of urine culture before operation.In MPCNL group,7 stones were stag-horn calculi.The diameter in 60 stones was more than 1.5 cm.Among them,56 stones located in the renal pelvis and upper middle calyces.4 stones located in the lower calyces.Multiple stones were found in 41 cases and single stone was found in 16 cases.4 cases had the history of unilateral urolithiasis.2 cases had the positive results of urine culture before operation.The mean stone size in MPCNL was larger,but the difference was not statistically significant (P ＞ 0.05).No statistical significance was found between the two groups in sex,age,preoperative urine,positive culture,patients with renal staghorn calculi,percentage of multiple calculi,stones in lower calyx and operation history of the same side(P ＞ 0.05).The urine white blood cells between the two groups were statistically significant (P ＜0.01),but the urine white blood cells in RIRS before placing double J stent had no significant difference with those in MPCNL.Results In RIRS group,The mean operative time was(90.2 ± 17.8) minutes.The mean hemoglobin deficit was (7.9 ± 7.9)g/L.The complication rate was 7.5％ (3/40).The postoperative hospital stay was (5.0 ± 2.3) days.The hospitalization cost was (42 994.1 ± 9 747.8) yuan.Stone-free rates after one session was 72.5％ (29/40).After second procedure,stone-free rates were up to 90.0％ (36/40).In MPCNL group,the mean operative time was (77.8 ± 15.6) min.The mean hemoglobin deficit was (10.0 ± 7.1) g/L.The complication rate was 24.6％ (14/57).The postoperative hospital stay was (8.0 ±2.5) days.The hospitalization cost was (24 626.3 ± 6 324.7) yuan.The stone-free rate after one session was 82.5％ (47/57).After second procedure,stone-free rates were up to 94.7％ (54/57).In statistics,there was no significant difference in hemoglobin drop,the stone-free rate on one session and the final stone-free rates(P ＞ 0.05).But significant difference existed in operative time,complications rate,postoperative hospitalization time and hospitalization cost (P ＜ 0.05).Conclusion Both RIRS and MPCNL are feasible,safe and minimally invasive way to treat renal calculi(≥ 1.5 cm) in pediatric patients.The stone-free rates between the two groups are comparable.RIRS has an advantage in postoperative hospitalization time and postoperative complications.MPCNL takes the advantage of operation time,hospitalization cost and needn't routinely places the double-J ureteral stent.
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Objective To evaluate the efficacy and safety of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure in the treament of intrarenal and proximal ureteral stones.Methods From November 2014 to December 2016,a total of 372 patients,including 200 males and 172 females,with upper urinary tract calculi were studied.The average age of patients was 48.1 years old.The average size of stone was 5-35mm,mean 15.7mm.There were 272 cases of renal calculi,80 cases of ureteral calculi and 20 cases of renal calculi combined with ureteral calculi.There were 252 cases of single calculi and 127 cases of multiple calculi.There were 237 cases of urinary tract infection and 14 cases of bacteremia.All patients were treated by suctioning fiexible uretemscopy with automatic control of renal pelvic pressure by a patented intelligent system including an irrigation and suctioning platform and a ureteral access sheath with a pressuresensitive tip.Statistical analysis was performed regarding renal pelvic pressure,operative time,stone-free rates,and complications.Results Three hundred and thirty of 372 patients only accepted one surgery to remove the stone.There were 12 cases of upper ureteral calculi were converted to ureteroscope lithotripsy.Seventeen cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis.Seven cases who failed the first surgery due to difficulty in placing the ureteral access sheath but flexible ureteroscopy were successfully performed in these patients after indwelling a D-J stent for 2 weeks.No stone was found in 6 cases,and the soft endoscope of ureter was examined.In all patients,the renal pelvic pressure of the pelvis was controlled within 20 mmHg.The average operative time was 15-180 min(mean 58.9 min).The stone-free rates was 95.55％ (322/337),the incidence of postoperative fever was 2.97％ (10/337),the sepsis rate was 1.19％ (4/337),the incidence of urinary sepsis was 0.89％ (3/337),the incidence of lumbago caused by extravasation was 0.59％ (2/337),and no peripheral viscera injury or death case.There was no statistically significant difference between preoperative and postoperative white and red blood cells (P ＞ 0.05).Conclusions This new type of suctioning flexible ureteroscopy with intelligent pressure-control has the advantages of perfusion attraction,pressure feedback,intelligent control and visualization of intracavity pressure.It could be a new type of operation with high safety,low complication and high stone free rate.
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Objective To evaluate the efficacy and safety of super-mini-percutaneous nephrolithotomy (SMP),retrograde intrarenal surge~(RIRS) for children with upper urinary tract calculus.Methods Clinical data of 85 children with upper urinary tract calculi treated by SMP or RIRS from April 2016 to June 2018 were retrospectively analyzed.Patients were divided into two groups according to operative method:group SMP and group RIRS.In group SMP:there were 38 male and 14 female patients;the mean age was (4.6 ± 2.7) years;the mean stone size was (15.2 ± 4.8) mm;17cases in left side,and 35 cases in right side;multiple stones were found in 18 cases and single stone was found in 34 cases.In group RIRS:there were 18 male and 15 female patients;the mean age was (4.6 ± 3.1) years;the mean stone size was (14.2 ±5.1)mm;9 cases in left side,and 24 cases in right side;multiple stones were found in 11 cases and single stone was found in 22 cases.No statistical significance was found between the two groups in sex,age,stone size,stone side (left/right),percentage of multiple calculi (P ＞ 0.05).Patients were evaluated with KUB radiography or CT after 1 month.The overall stone-free rate and complications of the two groups were compared.Results Group RIRS compared to group SMP showed longer operative time [(74.2 ± 31.8) min vs.(57.9±27.8)min,P =0.015],and hospital stay after operation [(4.8 ±2.8)days vs.(3.1 ±1.3) days,P =0.003].The overall stone-free rate was 90.4％ (47/52) for group SMP,and 48.5％ (16/33) for group RIRS(P ＜ 0.01).The re-treatment rate was significantly higher in group RIRS compared to group SMP[36.4％ (12/33) vs.1.9％ (1/52),P ＜ 0.01].The complication rate was 9.6 (3/52) and 27.3％ (9/33) for groups SMP and RIRS,respectively (P ＜0.05).Conclusions SMP was more effective than RIRS to obtain a better stone free rate,less complications and re-treatment rate in children with upper urinary tract renal calculus.