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【Objective】 To investigate the safety and efficacy of flexible vacuum aspiration ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal and upper ureteral calculi. 【Methods】 Clinical data of 41 cases treated in our hospital were retrospectively analyzed, including 20 cases treated with flexible vacuum aspiration ureteral access sheath (experimental group), and 21 cases treated with traditional ureteral access sheath (control group). The stone-clearance rate, operation time, postoperative fever (T>37.5 ℃), length of hospital stay and hospitalization costs were compared between the two groups. 【Results】 All operations were successful. The experimental group had significantly shorter operation time than the control group [(54.0±19.8) min vs. (76.6±20.1) min, P0.05). 【Conclusion】 Flexible vacuum aspiration ureteral access sheath in flexible ureteroscopic lithotripsy can shorten the operation time, improve stone-clearance rate and reduce incidence of postoperative fever, which is worth promoting.
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During the operation of flexible ureteroscope, the ureteral access sheath is effectively placed, which accelerates the circulation of fluid in the kidney, thus reducing the pressure in the kidney and enhancing the clarity of the operation field. The success rate of lithotripsy and the risk of postoperative infection depend on the position of the ureteral access sheath. This article reviews the factors affecting the insertion process of the ureteral access sheath and the methods to improve the success rate of the insertion of the ureteral access sheath.
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Objective:Objectives To introduce the preliminary experience of flexible vacuum-assisted ureteral access sheath(FV-UAS) in the treatment of upper urinary calculi in retrograde intrarenal lithotripsy(RIRS).Methods:The clinical data of 11 patients with upper urinary calculi who were treated in Jiangxi Provincial People's Hospital from August to September 2021 were analyzed retrospectively. There were 6 males and 5 females, with the mean age of 48 years (32-72 years), the mean size of stone of 15.5 mm (11-20mm), and the mean stone volume of 1 958 mm3 (1 108-4 036 mm3), including 1 case with upper ureteral calculi, 10 cases with renal calculi, and 2 cases with calculi in multiple renal calyces. Ureteral stents were placed in 2 cases preoperatively. There were 2 cases of grade Ⅱ hydronephrosis according to Grignon classification. All patients were treated by retrograde intrarenal lithotripsy, and the FV-UAS(F12/14) was used during the operation. FV-UAS can be passively bent(>90°) with the bending of the flexible ureteroscopy(f-URS), and connect vacuum suction devices. The method of placing the FV-UAS during the operation was the same as traditional ureteral access sheath. The FV-UAS should be as close to the target stone as possible by the f-URS during the operation. F6 ureteral stent was routinely indwelled for 2-4 weeks. The operation time, postoperative complications, and stone volume clearance rate were summarized and analyzed, and stone volume clearance rate was calculated as(1-residual stone volume/preoperative stone volume)×100%. The stone volume was obtained by CT 3-D reconstruction preoperatively and first day postoperatively.Results:All patients underwent RIRS successfully at the first stage, with the usage of FV-UAS(F12/14)during the operation. The mean operation time was 57.1 minutes(34-90 minutes), and the mean stone volume clearance rate was 98.9%(94.8%-100.0%)on the first day postoperatively. Seven cases reached 100.0% stone-free rate, and 4 cases presented residual calculi. The mean hemoglobin drop was 0.8 g/L, and 1 case presented vomiting without fever on the first day postoperatively. For the 4 cases with residual calculi, no residual stone was found by B-ultrasound when the ureteral stent was removed.Conclusions:Our preliminary study found that it is feasible and safe to use FV-UAS in RIRS, which can follow the f-URS to extend into the renal pelvis and renal calyces. Vacuum-assist can increase the probability of stone-free.
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Objective To investigate the safety and efficacy of ureteral access sheath (UAS) with vacullm suction during flexible ureteroscopy lithotripsy in treatment of renal stones. Methods 96 cases of renal stones patients who received flexible ureteroscopy lithotripsy were retrospectively analyzed and divided into two groups:control group with 50 cases and treatment group with 46 cases. The stones free rate, operation time, intrapelvic pressure, renal colic, formation of steinstrasse, SIRS, Calcitonin Zymogen, leukocyte count, hospitalization time, hospitalization costs and treatment efficiency were evaluated after one month. Results The average, maximum and minimum intrapelvic pressure of treatment group was much lower than that of control group (P < 0.05); After one month, the treatment efficiency and stones free rate of control group was 70.0% and 82.0%, lower than that of treatment group (P < 0.05); The operation time of control group and treatment group was(108.6 ± 3.5) min, (86.3 ± 5.2) min (P < 0.05); The cases of renal colic, steinstrasse and SIRS of control group after treatment was 13 cases, 11 cases, 10 cases which was more than that of treatment group with 2 cases respectively (P < 0.05); The hospitalization time, hospitalization costs of control group and treatment group was (8.8 ± 1.1) d, (23 067.5 ± 392.8) RMB and (7.7 ± 1.2) d, (21 957.3 ± 378.6) RMB (P < 0.05); The Calcitonin Zymogen, leukocyte count of control group and treatment group was (1.5 ± 0.3) and (0.3 ± 0.1) ng/ml, (14.6 ± 0.5)×109/L and (6.4 ± 0.6)×109/L (P < 0.05). Conclusion The application of ureteral access sheath with vacullm suction during flexible ureteroscopy lithotripsy in treatment of renal stones was simple, safe and effective, and can shorten the operation time, improve the rate of clearing stone and treatment efficiency, reduce the incidence of adverse reactions. The application can be extended.
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Objective To investigate the safety and efficacy of ureteral access sheath (UAS) with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones.Methods The clinical data on 56 patients with infectious renal stones who received flexible ureteroscopic lithotripsy were retrospectively analyzed.The patients were randomly divided into group A (26 patients) and group B (30 patients).Intrapelvic pressure,stoneclearance rate,surgical duration,formation of steinstrasse,postoperative fever (temperature ＞ 38.5 ℃C),PCT,leukocyte count,length of hospital stay,and hospitalization cost were evaluated.Results Intrapelvic pressure was much lower in group A than in group B;stone clearance rate was 96.2％ for group A and 83.3％ for group B;and surgical duration was (80.1 ± 2.2) min and (105.2 ± 3.5) min,respectively.One patient developed steinstrasse and one had postoperative fever in group A,while six patients developed steinstrasse and 4 had postoperative fever in group B;PCT and leukocyte count was much lower in group A than in group B.There were statistical differences between the two groups (P ＜ 0.05).The length of hospital stay and hospitalization cost were (7.4 ± 0.8)d and (20857.1 ± 389.4) RMB for group A and (8.2±1.3)d and (22008.5±394.3) RMB;but there were no statistical differences between the two groups (P ＞ 0.05).Conclusions Application of ureteral access sheath with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones was safe and effective.It can shorten surgical duration,improve stoneclearance rate and reduce incidence of adverse reactions.This procedure has better value of clinical application.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To evaluate the effect of micropercutaneous nephrolithotomy(microperc) for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath.Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017,Male,12 cases,female,11 cases.The mean ±SD (range) patient age was (49 ±14) years(28-67 years),stone volume was (1.7 ± 0.6) cm (1.0-3.0 cm) and stone density was (934.5 ± 282.7) HU (357-1 500 HU).The self-made all-seeing system consists of a puncture needle (F4.85) and two 3-way connector allowing the insertion of a flexible microoptic system,laser fiber and attaching to irrigation system.Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation.The course of puncture could be " all-see" on the display which was connected with flexible microoptic system.After stone fragmentation,the procedure was terminated in tubeless fashion.Ureteral double J stent was inserted in order to prevent postoperative complications.The factors analysed were demographic variables including age,sex,stone volume,stone density [Hounsfield units (HU)] and stone location,and intra-and peri-operative variables such as operating time,drop in haemoglobin level,stone clearance and complications.Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision.The mean ± SD (range) operation duration was (46.2 ± 19.9) min (20-120 min),pain score was 2.8 ± 1.2(1-6),hemoglobin decrease was 6.6 g/L,and in hospital time was (2.9 ± 0.8) d (2-5 d),respectively.No patient required blood transfusion.Stone-free rate at 1 and 3 months postoperation was 90.9％ (20/22) and 100 ％ (22/22),respectively.Two who suffered hematuria (Clavien Ⅰ)underwent conservative treatment and recorered well.One suffered urinary tract infections (Clavien Ⅱ) and was treated with antibiotics.There were no major complications.Conclusions Mircoperc with the self-made device and ureteral access sheath in management of renal calculi is feasible and effective.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To investigate the clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.Methods From March 2013 to July 2015,there were 68 patients accepted a ureteral access sheath in flexible ureteroscopy with the help of rigid ureteroscope for the treatment of kidney stones.There were 46 cases male,22 cases female,aged from 22 to 76 years old,average 43.9 years.There were 68 cases with backaches or hematuria.There were 48 cases with single stone,20 patients with multiple stones.There were 5 cases with stones on both sides.The stone diameter were from 1.2 to 2.5 cm,the average (1.83 ± 0.16) cm.There was no hydronephrosis in 18 cases,mild hydronephrosis 42 cases.The operations were carry out under general anesthesia.By using rigid ureteroscope placed zebra guidewire,then intercept F8 single lumen tip to 1.0 cm section on rigid ureteroscope,was placed into a modified 42 cm ureteral access sheath.Then the modified 42 cm ureteral access sheath was inserted under direct view with the help of rigid ureteroscope.Preoperative patient characteristics,radiographic stone size,operation time,success rate of lithotripsy,serious complications especially ureteral injury was recorded.4 weeks and 12 weeks after operation,ultrasound and/or CT were reexamined to assess the success rate of lithotripsy and the incidence ureteral stricture.Results All the procedures were successful.The operation time was (62.2 ± 6.5)min,the hospital stay was (3.1 ± 0.2) d.The success rate of ureteral access sheath completely placement was 97.1％,partially placement was 2.9％.Postoperative complications included Clavien classification grade Ⅰ 6 cases and grade II 2 cases.The postoperative follow-up averaged (12 ± 1.2) months for all case.The success rate of lithotripsy was 76.5％ in 4 weeks postoperative,and it was 95.6％ in 12 weeks.During the follow-up,compared with the preoperative cases,62 cases were not found to increase the degree of hydronephrosis.There were 58 cases (58/62) without hydronephrosis.4 cases were mild hydronephrosis (4/62).CT showed normal ureter 52 cases (52/52).Conclusions It was safe and reliable procedure with good results.It would be a safe procedure to inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.
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Objective To investigate the application value of a pressure-measuring and stone-extracting ureteral access sheath (UAS) used together with negative pressure suction system during flexible ureteroscopy in the treatment of renal caculus.Methods A retrospective analysis was performed on the 98 cases of renal caculus who received flexible ureteroscopic holmium laser lithotripsy (FURS) in the Department of Urology of the Kunming General Hospital of Chengdu Military Command from November 2014 to September 2015,and the enrolled cases were divided into two groups:group A and group B.The new UAS was used in group A combined with vacuum suction during lithotripsy,and simple manometry type UAS was used in group B.The infusion pump flow rate of 0.2 L/min was set in the operation,the perfusion pressure limit was set to 100 mmHg,the suction pressure of group A was 10 kPa.Perfusion flow rate and pressure was adjusted in a timely manner based on the clear vision and the internal pressure force on the kidney.Then we recorded and compared the internal pressure and variation trend of renal and perfusion time of two groups.Results Two groups of patients were successfully completed surgery.The renal pressures in group A were adjusted duly and were lower than the that in group B in the whole process of operation.The average renal pressure in group A was 10.88 ± 5.91 1mmHg.The average renal pressure in group B was 20.10 ± 7.68 mmHg,the pressure control was difficult and unsteady.Conclusion The new type of UAS in the flexible ureteroscopic holmium laser lithotripsy (FURS) can make the renal pressure in surgery controllable and is safe for the FURS.