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【Objective】 To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope (SMP) combined with flexible ureteroscopic lithotripsy (FURL) in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi. 【Methods】 Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed, including 47 cases complicated renal calculi, and 14 cases of lower calyceal calculi with infundibulopelvic angle ≤30°. SMP combined with FURL was performed in 23 cases (combined group), and FURL alone was performed in 32 cases (FURL group). The operation time, hemoglobin reduction, postoperative hospital stay, hospitalization expenses, stone-clearance rate and complications were compared. 【Results】 All operations were successful. Compared with the FRUL group, the combined group had significantly more hemoglobin reduction [(16.30±10.17) g/L vs. (6.94±6.61) g/L], longer postoperative hospital stay [(5.35±1.61) d vs. (3.19±1.26) d], and higher hospitalization expenses [(22 481±2 234) yuan vs. (18 209±2 584) yuan] (P0.05]. One month after surgery, CT results showed that the combined group had higher stone-clearance rate (91.30% vs. 65.63%, P=0.027). There was no difference in the complication rate (21.74% vs. 21.88%, P>0.05). One case (4.35%) in the combined group and 5 cases (15.63%) in the FURL group received retreatment (P>0.05). 【Conclusion】 SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi, with high stone-clearance rate and low complication rate.
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Objective:To summarize the preliminary clinical experience of endoscopic treatment of upper urinary tract urothelial carcinoma, and to analyze its indications and efficacy.Methods:The clinical data of 14 patients underwent endoscopic treatment for upper urinary tract urothelial carcinoma in our hospital from December 2014 to December 2019 were retrospectively analyzed. Among them, there were 5 males and 9 females, with a median age of 75.5(44-84) years. There were 11 patients with hematuria, 2 patients with flank pain and one asymptomatic patient. Five patients had a history of bladder cancer and one had a history of contralateral UTUC. There were 4 patients with solitary kidney, 3 patients with renal insufficiency, 1 patient with bilateral renal pelvis carcinoma, 4 patients prohibitory to nephroureterectomy because of poor general condition (American Society of Anesthesiologists score ≥3), and 2 patients were pathologically diagnosed as low-grade non-invasive urothelial carcinoma and requested renal preservation therapy. A total of 15 renal units included. The main tumor sites were renal pelvis in 6 renal units, upper calyx in 4 renal units, middle calyx in 3 renal units, and lower calyx in 2 renal units. The median tumor diameter was 2.0 (0.8-4.0) cm. All patients were diagnosed with urothelial carcinoma by preoperative computed tomography (CT/CTU), magnetic resonance imaging (MRI), and cytological or pathological biopsy. In 13 patients, ultrasond-guided percutaneous renal access and tract dilation were performed to establish a F24 standard tract. The tumor tissues were vaporized by 1470 semiconductor laser (60-80 W) or thulium laser (15-20 W) under nephroscopy, and electrocoagulation was used to coagulate the bleeding when necessary. Two patients were treated with felxible ureteroscope, under which tumor ablation was performed with 200 μm holmium laser fiber, and neodymium laser was used for hemostasis. The range of tumor vaporization ablation included 0.5-1.0 cm normal renal pelvis mucosa around the tumor, deep to the fatty layer of renal sinus. Biopsy was taken again at the base of the wound after vaporization ablation when necessary.Results:In this study, six sites were pathological high grade, 9 sites were pathological low grade tumors. Eight were in pathological T a stage, 5 in T 1 stage, and 2 in T 2 stage. The median blood loss was 20.0 (2-50) ml. There were 5 postoperative complications, including one patient with fever (body temperature >38.5℃) and 4 patients with hemorrhage requiring blood transfusion (postoperative hemoglobin <70 g/L) with 2-4 U suspended red blood cells.No patient underwent embolization. The median follow-up time were 31(11-70)months. Ten patients experienced recurrence, and the median time to recurrence was 11.3 (4-41) months. Four of them received conservative treatment after recurrence, including immunotherapy and radiotherapy in 1 patient, systemic chemotherapy in 1 patient, and watchful waiting in 2 patients. Three of them received repeated endoscopic treatment after recurrence, including 2 patients with percutaneous nephroscopic laser ablation and 1 patient with transurethral resection of bladder tumor, all of them survived during the follow-up period. Three patients underwent full-length nephroureterectomy after recurrence, 2 died and 1 survived during the follow-up period. Six patients eventually died, and the median time of death after surgery was 21(9-33) months. Five of them died from tumor-specific death and one died from gastric perforation. The median tumor-free survival interval were11 (4-41) months during the follow-up period. The 2-year tumor-specific survival rate was 78.6%, 50% for high-grade patients and 100% for low-grade patients. Conclusions:In patients who were in early stage (≤T 2) and intolerant to the nephroureterectomy, or with solitary kidney, renal insufficiency, or bilateral tumors, endoscopic treatment could be used as an alternative treatment approach for upper urinary tract epithelial carcinoma, especially for low-grade non-invasive patients.
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Objective:To evaluate the clinical efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of perirenal abscess.Methods:The clinical data of 11 patients with perirenal abscess admitted to Zhejiang Provincial People's Hospital from January 2013 to February 2021 were retrospectively analyzed. There were 4 males and 7 females. The average age was 59(51-76) years. The abscess was located on the left side in 4 cases and on the right side in 7 cases. The average diameter of abscess was 11.2(8.1-19.2) cm. All patients had fever, low back pain and abdominal mass, accompanied by bladder irritation in 6 cases, gross hematuria in 5 cases, abdominal distension, nausea and anorexia in 3 cases. There were 7 cases with type 2 diabetes, 2 cases with rheumatoid arthritis and 6 cases with ipsilateral kidney and ureter stone. Among the 11 patients, 6 had a history of urinary tract infection, 1 had a history of upper respiratory tract infection, 1 had secondary infection of perirenal hematoma after traumatic renal rupture, and 3 had secondary infection of perirenal hematoma after percutaneous nephroscopy. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, intraoperative blood loss, drainage volume, drainage tube indwelling time, postoperative body temperature returned to normal time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results:All operation procedures of 11 patients were successfully completed, including 8 cases of single channel, 2 cases of double channels and 1 case of three channels. The average operation time was 44(20-74)min, the average amount of blood loss was 15(10-20)ml, the average amount of pus was 325(200-500)ml, the average indwelling time of drainage tube was 8(6-12)d, the average time of body temperature returned to normal was 0.9(0.5-2.0)d, and the average hospitalization time was 9.6(7.0-14.0)d. Before discharge, CT reexamination showed that the perirenal abscess disappeared. There were no serious complications during and after operation. The average follow-up time was 4.4(3-8) months. There was no recurrence in all patients.Conclusions:Ultrasound negative pressure suction with percutaneous nephroscope is one of the safe and effective surgical methods for the treatment of perirenal abscess. It has the advantages of small trauma, quick recovery, complete drainage, exact effect and fewer complications.
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Objective@#To investigate the clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 13 patients with retroperitioneal abscess after common bile duct exploration who were admitted to Xinjiang Autonomous Region Hospital of Chinese People′s Armed Forces between January 2004 and December 2018 were collected.There were 5 males and 8 females, aged from 34 to 81 years, with an average age of 57 years. All the 13 patients underwent debridement and drainage for retroperitioneal abscess under percutaneous nephroscope. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was performed using outpatient examination and telephone interview to detect postoperative choledocholithiasis recurrence up to September 2019. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers.@*Results@#(1) Surgical and postoperative situations: all the 13 patients underwent successfully debridement and drainage for retroperitioneal abscess under percutaneous nephroscope, without kidney injury, pancreatic damage, vascular injury or peritoneal damage. There were 11 cases with 1 drainage tube, and 2 cases with 2 drainage tubes. The operation time, volume of intraoperative pus extracted, time to body temperature resuming to normal of 13 patients were 41 minutes (range, 24-77 minutes), 241 mL (range, 110-640 mL), 1.5 days (range, 1.0-4.0 days), respectively. The time to postoperative removal of drainage tube of 13 patients was 42 days(range, 5-94 days), in which the time to postoperative removal of drainage tube at right iliac region was 5 days and 11 days in 2 patients, and at lower back was 23-94 days in 11 patients, respectively. Duration of postoperative hospital stay was 42 days (range, 26-67 days). All the 13 patients had pleural effusion disappeared, and were cured and discharged. (2) Follow-up: 13 patients were followed up for 6-48 months, with a median time of 18 months. No recurrence occurred.@*Conclusion@#The treatment with percutaneous nephroscopy is safe and effective for retroperitioneal abscess after common bile duct exploration.
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Objective To investigate the clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration.Methods The retrospective and descriptive study was conducted.The clinical data of 13 patients with retroperitioneal abscess after common bile duct exploration who were admitted to Xinjiang Autonomous Region Hospital of Chinese People's Armed Forces between January 2004 and December 2018 were collected.There were 5 males and 8 females,aged from 34 to 81 years,with an average age of 57 years.All the 13 patients underwent debridement and drainage for retroperitioneal abscess under percutaneous nephroscope.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up was performed using outpatient examination and telephone interview to detect postoperative choledocholithiasis recurrence up to September 2019.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers.Results (1) Surgical and postoperative situations:all the 13 patients underwent successfully debridement and drainage for retroperitioneal abscess under percutaneous nephroscope,without kidney injury,pancreatic damage,vascular injury or peritoneal damage.There were 11 cases with 1 drainage tube,and 2 cases with 2 drainage tubes.The operation time,volume of intraoperative pus extracted,time to body temperature resuming to normal of 13 patients were 41 minutes (range,24-77 minutes),241 mL (range,110-640 mL),1.5 days (range,1.0-4.0 days),respectively.The time to postoperative removal of drainage tube of 13 patients was 42 days (range,5-94 days),in which the time to postoperative removal of drainage tube at right iliac region was 5 days and 11 days in 2 patients,and at lower back was 23-94 days in 11 patients,respectively.Duration of postoperative hospital stay was 42 days (range,26-67 days).All the 13 patients had pleural effusion disappeared,and were cured and discharged.(2) Follow-up:13 patients were followed up for 6-48 months,with a median time of 18 months.No recurrence occurred.Conclusion The treatment with percutaneous nephroscopy is safe and effective for retroperitioneal abscess after common bile duct exploration.
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BACKGROUND: This study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast.METHODS: Between January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into three groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively com-pared between three groups.RESULTS: No statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1, 71.3±46.6 min; group 2, 33.0±13.7 min; and group 3, 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient.CONCLUSION: Nephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.
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Humans , Cystoscopes , Cystoscopy , Retrospective Studies , Sex Ratio , Ultrasonics , Urinary Bladder Calculi , Urinary BladderABSTRACT
<p><b>Objective</b>To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.</p><p><b>METHODS</b>This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.</p><p><b>RESULTS</b>Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.</p><p><b>CONCLUSIONS</b>The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.</p>
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Humans , Male , Calculi , Diagnostic Imaging , General Surgery , Ejaculatory Ducts , Endoscopes , Endoscopy , Genital Neoplasms, Male , Hemospermia , Diagnosis , Therapeutics , Holmium , Lasers, Solid-State , Lithotripsy , Magnetic Resonance Imaging , Natural Orifice Endoscopic Surgery , Neoplasm Recurrence, Local , Postoperative Complications , Reproducibility of Results , Seminal Vesicles , Diagnostic Imaging , UrethraABSTRACT
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 explore the effect of therapeutic application of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound and holmium laser lithotripsy for complex kidney stone. Methods: 124 patients with complex renal calculus were selected and divided into observation group (62 cases) and control group (62 cases) as randomly number table. The patients of observation group were cured by pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound while patients of control group were cured by holmium laser lithotripsy. A series of correlative indicators, such as some correlative indexes in during and post operation, complication situation of post operation and kidney function, were compared. Results:The differences about bleeding volume during operation and postoperative hospital stay between the two groups were significant (t=12.475, t=7.659, P<0.05). For clearance rate of calculus and incidence of complication, the differences between the two groups were significant (x2=6.048, x2=7.159, P<0.05). And the differences of separation index of renal pelvis collective system, creatinine and urea nitrogen post treatment between the two groups also were significant (t=8.529, t=7.058, t=10.596, P<0.05). Conclusion: Comparing with the traditional holmium laser lithotripsy, the clinical better effect of pneumatic ballistic lithotripsy under percutaneous nephroscope ultrasound for complex renal calculi is significant. Its series of advantages, such as shorter operation time, faster recovery, safer and reliable for patients and lower incidence of postoperative complication and so on, can effectively relieve the renal function for patients.
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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 investigate the clinical efficacy of two different single orifice laparoscopic surgeries for patent processus vaginalis in children. Methods From August 2013 to June 2015,there were 84 children with patent processus vaginalis in the First Affiliated Hospital of Guangxi University of Science and Technolgy. They were divided into two groups ( A and B ) randomly according to different laparoscopic surgeries. Group A:used ordinary micro?laparoscope, single orifice, and double channel. Group B:used Li Xun nephroscope,single orifice,single channel. Both two groups′ the high ligation of the sheath was performed with the aid of the auxiliary forceps in the mirror under surveillance. The mean unilateral operation time, mean postoperative hospitalization duration,complications and recurrences of two groups were compared. Results All children underwent successful laparoscopic surgery,without transfering to open surgery,and unilateral operation time was (12. 53±3. 22) min for group A,(10. 16±2. 79) min for group B,the difference was significant(P=0. 037). The mean postoperative hospitalization duration was (2. 29±0. 57) d in group A,(2. 25±0. 55) d in group B, the difference was not significant ( P= 0. 671 ) . There was no complication and recurrence in two groups. Conclusion laparoscopic percutaneous extraperitoneal closure use Li Xun nephroscope,single orifice, single channel for children is safe and effective,and it is more convenient and less invasive than the conventional micro?laparoscope.
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Objective To investigate the difficulties of building channel in ultrasound-guided percutaneous nephrolithotomy (PCNL).Methods Surgical processes of 45 patients underwent PCNL were recorded.The difficulties and causes in building channel were analyzed.Results In the process of building channel in PCNL,60 cases of difficulties happened,41.7％ (25/60) because of depth inaccuracy of puncture and dilation,18.3％(11/60) because of angle deviation of tract dilation,15.0％(9/60) result from nondilated collecting system,13.3％(8/60) because of lacking experience in ultrasound observation.Conclusions The most often encountered difficulties is depth inaccuracy of puncture and dilation in building channel,next is angle deviation of tract dilation.To improve technique detailes is the key to gain success.
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Objective To evaluate the clinical value of the combination of S-shaped urethral dilator and nephro-scope for the treatment of male urethral stricture disease. Methods Guidewires were inserted into bladder through the nephroscope under direct vision. The urethral dilation with S-shaped urethral dilator was carried out by nephroscope in 41 male patients. All catheters were located across the strictures and remained for 4-6 weeks. The regular follow-up was done on all cases to assess the clinical effect on urine flow. Results All surgeries were successful without serious complications. The mean operative time was (40.16 ± 5.78) min. The voiding symptoms were significantly improved after catheter removal compared with those of preoperation in all cases. Patients were followed up after surgery and were regularly urethral dilation at least 6 weeks. The mean follow-up time was (34.75±6.42) weeks.There were incontinence, diminished sexual function and other complications after operation in all cases. Conclusion Nephroscope combined with S-shaped urethral dilator for the treatment of male urethral stricture disease is feasible, minimally invasive and safe, which is worthy of recommendation.
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Objective Infected pancreatic necrosis is a serious complication of necrotizing pancreatitis. A method of minimally-invasive retroperitoneal infected pancreatic necrosectomy using percutaneous nephroscope was evaluated. Methods 21 patients with acute pancreatitis were treated in our hospital from June 2008 to August 2009. Among 13 patients who developed infected pancreatic necrosis, 6 underwent percutaneous catheter drainage by CT guidance. Then retroperitoneal infected pancreatic necrostectomy using percutaneous nephroscope along the sinus tract were performed after drainage for 5-36 d. Results In these 6 patients, 3 received percutaneous nephroscopic treatment one time, 2 two times and 1 three times. There were no operative mortality and morbidity except that 1 patient developed pseudocyst 6 months after operation. Conclusion Retroperitoneal pancreatic necrosectomy by percutaneous nephroscope is a safe, feasible, minimally-invasive and efficient method for treating infected pancreatic necrosis when the indication and occasion are suitable. This method would be a valid therapeutic option for treating necrotizing pancreatitis. However, further evaluation is necessary.
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Objective To explore the operative cooperation and nursing points of holmium laser lithotripsy under percutaneous nephroscope. Methods A retrospective study was carried out to investi-gate the operative cooperation and nursing of 38 patients receiving holmium laser lithotripsy under percuta-neous nephroscope in our hospital from March 2006 to August 2007. Results Stones were completely cleared in 31 patients at first holmium laser lithotripsy,in 5 patients at second holmium laser lithotripsy,in 2 patients at third holmium laser lithotripsy. One patient complicated with water intoxication and septicemia. Operation time ranged from 50 to 190 minutes,blood loss volume reached 50 to 200 ml with a average of 100 ml.No blood transfusion was needed during the operations and no secondary hemorrhage was seen postoperation. Double J catheter was inserted and indwelled for 30 to 60 days with a average of 38 days. Postoperative follow-up was satisfying. Conclusions Holmium laser lithotripsy under pereutaneous nephroscope possesses the advantages of little trauma,hemorrhage and complication and quick recovery.It is the best choice for treatment of calculus in urinary system.
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Objective To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods Under the guidance of B-ultrasonography,a F_(24) working channel for percutaneous nephroscopy was established.Renal stones were fragmented and extracted under a F_(20.8) nephroscope by using the LithoClast Master(EMS,Switzerland).Results The time for unilateral complete stone clearance was 5~115 min(mean,35 min).All the stones were successfully fragmented and the stone clearance rate was 91.8%(45/49).The renal fistulization tube was removed at 4~6 days after operation and the urethral catheter was removed 2 days afterwards.The double-J tube was removed at 1 month after operation.The postoperative hospital stay was 4~6 days(mean,8 days).Residual stones
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Objective To evaluate the efficacy of percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy for the treatment of renal calculi. Methods From January 2005 to December 2006, 132 cases of renal calculi were treated by percutaneous pneumatic nephrolithotripsy and ultrasonic lithotripsy. Percutaneous nephrolithotripsy was performed under the guidance of B-ultrasonography, and then the calculi were removed by pneumatic nephrolithotripsy combined with ultrasonic lithotripsy.Results Single-tract procedure was performed on 122 cases, while two-tract in the other 10. One-stage lithotripsy was performed on 127 cases, and two-stage operation was carried out in 5. The operation time ranged from 30 to 150 minutes with a mean of (60?12) minutes. The stone clearance rate was 90.2% (119/132) one week after the operation. Five patients had 200-to 500-ml hemorrhage 1 to 4 days after the operation, and were cured by blood transfusion and anti-infection treatments. No serious complications were found in the other patients. The nephrostomy tube was withdrawn 4 to 7 days (mean 6 days) after the operation. The hospital stay was 6 to 22 days with a mean of 15 days. Among the patients, 98 were followed up for 3 to 20 months (mean 13 months). No hemorrhage, infection, or recurrence of renal calculi was found during this period. Conclusion Percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy is safe, effective, with mild surgical trauma and a few complications for patients with renal calculi.
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Objective To discuss the clinical significance of nephroscopic surgery for simple renal cysts. Methods A 2~4 cm incision was made below the 12th costal interspace. Through the incision the nephroscopic decortication was performed in 26 patients with simple renal cyst. Results The operation time was 20~80 min (mean, 30 min) and the postoperative hospital stay, 3~)6 days (mean, 4 days). No blood transfusion was required and no severe complications were noted. Follow-up observations for 3~)12 months (mean, 8 months) in the 26 patients found no recurrence. Conclusions Mini-incision nephroscopic decortication for renal cysts is feasible and mini-invasive, with advantages of simplicity of performance and quick postoperative recovery.