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Objective:To evaluate the efficacy of Paishi decoction in ureteral calculi treatment. Methods:Ureteral calculi patients were voluntarily divided into two groups in Shanghai Baoshan Traditional Chinese Medicine-Integrated Hospital. Patients in the control group received anti-inflammatory symptomatic treatment for 2 weeks， and patients in the treatment group received anti-inflammatory symptomatic treatment combined with Paishi decoction for 2 weeks. Results:There was no significant difference between the two groups in gender， age， body weight and stone size. Compared with the control group， after taking Paishi decoction for 2 weeks， the urinary oxalic acid and calcium in the treatment group decreased significantly， and the urine citric acid increased （P<0.05）. The difference in clinical effective rate was significant between the two groups （P<0.05）. Conclusion:Paishi decoction is superior to single anti-inflammatory symptomatic treatment in the treatment of ureteral calculi， which reflects the advantages of integrated traditional Chinese and Western medicine. However， the number of patients included in this study was limited， further studies are in need to verify the result.
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Objective@#To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic.@*Methods@#This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m2), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone position and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%.@*Results@#A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed.@*Conclusions@#The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic, and security is acceptable.
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Objective To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic.Methods This study was a prospective multicenter randomized controlled trial.The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent,patients' age ranged from 18-65 years old,ureteral calculi related with renal colic,stone diameter was less than 7 mm,patients were not treated with analgesia,antispasmodic drugs.The exclusion criteria was that combination of severe urinary tract infection,severe hydronephrosis,urinary malformation,severe hypertension,history of cerebrovascular disease,vital organ dysfunction,obesity (BMI ＞ 35 kg/m2),history of ureteral calculi exceeded 2 months,abnormal blood coagulation.Patients were randomized into observation group and control group using random number table method.The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively.The inclination angle was 24°.The secondary vibrator vibrated for 6 minutes,then the patient took the prone position and opened the main,the secondary vibrator.The treatment is completed after 6 minutes of vibration.The analgesic effect,stone removal,follow-up effects and adverse reactions in the two groups was compared.We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment × 100％.Results A total of 100 patients were included in the study,50 in the observation group and 50 in the control group.There were no statistical difference in the age of the two groups [(41.8 ± 11.7) years and (46.6 ± 13.9 years)],gender distribution [37(male)/13 (female) and 42(male)/8(female)],location of stones (in the observation group,19 cases in upper ureter,7 cases in the middle ureter and 24 cases in the lower ureter;in the control group,12 cases in the upper ureter,3 cases in the middle ureter,and 35 in the lower ureter),left and right distribution of stones [21 (right) / 29 (left) and 22 (right) / 28 (left)],long diameter of stones [(5.2 ± 0.9) mm and (5.1 ± 1.1) mm],VAS scores before treatment (7.5 ± 1.4 and 7.6 ± 1.5),and readmission rate [22 ％ (11/50) With 18％ (9/50)],1 week stone removal rate [70％ (35/ 50) and 64％ (32/50)].The incidence of adverse reactions was 8％ (4/50) in the observation group including 3 cases of nausea,1 case of vomiting.The incidence of adverse reactions was 4％ in the control group (2/50),which 2 cases showed nausea.The number of patients who chose EPVL,ESWL or surgery for the subsequent treatment in observation group was 35 cases,9 cases,and 6 cases respectively.The number of patients who chose EPVL,ESWL or surgery for the subsequent treatment in the control group was 35 cases,10 cases and 5 cases respectively.There was no significant difference between the two groups (P ＞0.05).The VAS score after treatment of the observation group was lower than that of the control group (2.4 ± 1.3 and 3.7 ± 1.5,P ＜0.01).The total effective rate of the observation group was higher than that of the control group [94％ (47/50) and 76％ (38/50),P ＜ 0.01].46 patients underwent urinary ultrasonography to check the degree of hydronephrosis.The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5％ (18/33) and 30.8％ (4/13)],but there was no significant difference between the two groups (P =0.146).In the upper ureteral calculi,the VAS score of the observation group was lower than that of the control group (2.4 ± 0.3 and 3.9 ± 0.4,P ＜ 0.01).There was no significant difference in the total effective rate between the two groups.In the lower ureteral calculi,the observation group had low VAS score after treatment.In the control group (2.4 ±0.2 and 3.5 ±0.2,P＜0.01),there was no significant difference in the total effective rate between the two groups;the middle segment stones were less included (l0 in total) and were not discussed.Conclusions The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic,and security is acceptable.
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Objective@#To explore comprehensive treatment for severe infection caused by ureteral calculus.@*Methods@#The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated.@*Results@#Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.@*Conclusion@#The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method.
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Objective To explore comprehensive treatment for severe infection caused by ureteral calculus.Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first,then ureteral calculus was treated.Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to emnpirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage Ⅰ,cystoscopic retrograde double J tube was accomplished in 3 patients,and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage Ⅱ,one patient with ureter stone-street was cured by lithagogue drugs,2 patients were successfully cured by ESWL,one patient by holmium laser lithotripsy under ureteroscope,2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae Ⅰ,combined with lithotripsy according to guidelines in the stage Ⅱ in treating severe infection caused by ureteral calculus have more advantage such as simple,less injury,rapid control of infection,less complication and satisfactory effect.It is an ideal method.
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Objective To observe the clinical efficacy of abdominal acupuncture plus Chinese medication in treating ureteral calculus. MethodA total of 106 patients with ureteral calculus were randomized into an abdominal acupuncture group (53 cases) and a medication group (53 cases). The abdominal acupuncture group was intervened by abdominal acupuncture plus medication, with Shuifen (CV9), Xiawan (CV10), Jianli (CV11), Zhongji (CV3), Guanyuan (CV4) and Qihai (CV6) selected as the major points. The removal of stones and the release of pain were observed in the two groups, and the efficacies were compared between the two groups.Result The two treatment methods both effectively improved the pain and promoted the removal of stones; the Visual Analogue Scale (VAS) scores were significantly changed after the intervention in both groups (P<0.05). The time taken to mitigate and release pain was significantly shorter in the abdominal acupuncture group compared to the other group (P<0.01). The total effective rate was 88.7% (47/53) in the abdominal acupuncture group, superior to 73.6% (39/53) in the medication group (P<0.05).ConclusionAbdominal acupuncture plus medication can effectively mitigate pain, promote the removal of stones and reduce patient's sufferings in treating ureteral calculus.
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Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.
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Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 ％ (35/43).SFR was 100％ in the patients with the stone burden less than 30 mm and 63.2％ in the patients with the stone burden ≥30 mm,the difference was statistically significant(P＜0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden ＜30 mm,which has higher stone clearance rate with good safety.
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Objective To observe the clinical efficacy of abdominal acupuncture plus Chinese medication in treating ureteral calculus. MethodA total of 106 patients with ureteral calculus were randomized into an abdominal acupuncture group (53 cases) and a medication group (53 cases). The abdominal acupuncture group was intervened by abdominal acupuncture plus medication, with Shuifen (CV9), Xiawan (CV10), Jianli (CV11), Zhongji (CV3), Guanyuan (CV4) and Qihai (CV6) selected as the major points. The removal of stones and the release of pain were observed in the two groups, and the efficacies were compared between the two groups.Result The two treatment methods both effectively improved the pain and promoted the removal of stones; the Visual Analogue Scale (VAS) scores were significantly changed after the intervention in both groups (P<0.05). The time taken to mitigate and release pain was significantly shorter in the abdominal acupuncture group compared to the other group (P<0.01). The total effective rate was 88.7% (47/53) in the abdominal acupuncture group, superior to 73.6% (39/53) in the medication group (P<0.05).ConclusionAbdominal acupuncture plus medication can effectively mitigate pain, promote the removal of stones and reduce patient's sufferings in treating ureteral calculus.
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Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.
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Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 ％ (35/43).SFR was 100％ in the patients with the stone burden less than 30 mm and 63.2％ in the patients with the stone burden ≥30 mm,the difference was statistically significant(P＜0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden ＜30 mm,which has higher stone clearance rate with good safety.
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Objective To assess the impact of preoperative ureteral stenting on outcome of flexible ureteroscopic lithotripsy . Methods The clinic data of flexible ureteroscope lithotripsy were analyzed retrospectively .All 52 eligible patients were divided into three group :goup A(no preoperative ureteral stenting );group B (preoperative ureteral stenting for 3-10 days);group C(preopera‐tive ureteral stenting for two weeks or more ) .The application of ureteral access sheath ,operation time ,stone free rates ,hospital stays ,complications were compared among the three groups .Results There were no significant differences in aging ,gender ,stone size , distribution ,average hospitalization days ,postoperative complications among the three groups (P>0 .05) .There were significantly differ‐ences between group A and group B ,group C(P0 .05) on the suc‐cess rate of indwelling ureteral access sheath ,average operation time ,stone free rate .Conclusion Preoperative ureteral stenting could en‐hance the success rate of indwelling ureteral access sheath ,shorten the operation time ,improve the stone free rate .There was similar out‐come of flexible ureteroscopic lithotripsy between preoperative ureteral stenting for 3-10 days and two weeks or more .
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Objective:To explore the reliability, availability and security of peel-away plastic film sheath combination of ureteroscopy pneumatic lithotripsy treatment of female lower segment complexity ureteral calculi.Methods: The treatment group(40 cases) used peel-away plastic film sheath establish a bridge sheath channel between the urethra, bladder and the ureteral opening, combining under ureteroscopy pneumatic lithotripsy treatment. The control group(40 cases) with traditional under ureteroscopy pneumatic lithotripsy treatment. The clinical data of two groups of patients were analyzed.Results: The cure rate of the treatment group was significantly higher than the control group(x2=5.54,P<0.05); and the stones operation time, the bleeding, hospital stays and hospital costs was much better than control group; the complications of surgery (except the ureteral perforation) was significantly less than that of control group.Conclusion: Treatment of female lower segment complexity ureteral calculi by using the peel-away plastic film sheath establish a bridge sheath channel between the urethra, bladder and the ureteral opening, combining under ureteroscopy pneumatic lithotripsy treatment, with safe, convenient, practical, low cost, little injury, fewer complications, etc. was worthy of clinical application.
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Objective To investigate the value of procalcitonin (PCT) for urosepsis secondary to ureteral calculus.Methods Samples of 68 ureteral calculi patients who were suspected of urosepsis were obtained for PCT level,C-reactive protein (CRP) level,blood routine examination,urinary sediment,blood culture and urine culture.Sixty-eighy patients were divided into urosepsis group and non-urosepsis group based on the urosepsis diagnostic standard.The age sex,stone location,stone size,blood WBC count,CRP level,PCT level and urine WBC count were compared between the 2 groups.PCT levels before and after treatment were also compared.Results The age,stone size in urosepsis group were significantly higher than those in non-urosepsis group.The PCT levels of patients in urosepsis group and non-urosepsis group were 19.09±25.15 μg/L and 2.09± 1.85 μg/L respectively before treatment,and there was a significant difference between the 2 groups (P＜0.05).The blood WBC counts (× 109/L) of patients in urosepsis group and non-urosepsis group were 11.00± 3.47 and 10.27±2.32 respectively before treatment (P＞0.05).The CRP levels of patients in urosepsis group and non-urosepsis group were 17.41±15.24 mg/L and 15.02±4.94 mg/L respectively before treatment (P＞0.05).The median urine WBC counts (per HPF) of patients in urosepsis group and non-urosepsis group were 54 and 47 respectively before treatment (P＞0.05).The PCT levels of patients in urosepsis group before and after treatment were 19.09 ± 25.15 μg/L and 1.06 ± 0.56 μg/L,and there was a significant difference (P＜0.05).Conclusion PCT has a definite value for early diagnosis of urosepsis,condition assessment and treatment guideline.
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Objective To evaluate the role and surgical curative effect of the holmium laser under minor-caliber ureteroscope (F4.5) for the treatment of incarcerated ureteral calculus. Methods The holmium laser under minor-caliber ureteroscope (F4.5) was used to treat the incarcerated ureteral calculus with the course more than 2 months in 286 cases (334 sides) . Results 262 patients (304 sides) were successful in operation of single cavity treatment, with success rate of 91.6%. Conclusion Long course incarcerated ureteral calculus often associated with ureteral obstruction lesions (narrow,polyp,granulation hyperplasia,ureter cyst,etc.). Compared with thick ureteroscopy, minor-caliber ureteroscope has high single success rate for the treatment of incarcerated ureteral calculus with high safety, less complications, high gravel and platoon stone rates, and simultaneous treatment of the ureteral obstruction lesions.
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Objective To investigate the therapeutic effects, safety of ureteral calculus accom panied with granulation treated with pneumatic lithotripsy and two-macron laser via transurethral uret eroscopic. Methods From June 2007 to March 2010, 38 cases of ureteral calculus accompanied with granulation were treated with 2 μm laser and pneumatic lithotripsy via ureteroscope. All the patients had middle to severe hydronephrosis. The granulation under the calculus was vaporized with the 2 μm laser, and then the ureteral stone was fragmented with pneumatic lithotripsy. The clinical datum,stone disintegration rate, lithagogue rate and complication were retrospectively analyzed. Results Among 38 cases of ureteral stones, rate of successful fragmentation in a single procedure was 92%(35/38). The operation time ranged from 15 to 45 min, mean (23.0±6.5)min. Estimated the intraoperative blood loss was (7.0±4.5)ml. The postoperative hospitalization time was (5.2±0.6)d. Two upper ureteral stones were pushed back to the renal pelvis and a conversion to extracorporeal shock wave lithotripsy (ESWL) was needed. The insertion of the ureteroscope was failed in 1 case who was accepted open operation finally. Among the 37 cases treated via ureteroscopy, stone clearance rate was about 86% after operation 1 month. Follow-up examinations for 3-15 months (mean 8 months)showed no ureteral stenosis or urinary infection. Conclusion 2 μm laser and pneumatic lithotripsyvia ureteroscope could be a highly effective and safe therapy for treatment of ureteral stone with granulation.
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Objective To evaluate the efficacy of gentamicin solution in transurethral ureteroscopic lithotripsy to prevent postop- erative infection.Methods Prospective clinical randomized control study was conducted.From July 2003 to June 2006,116 ca- ses of ureteral stones at high risk of postoperative infection were randomized into control group or gentamicin group.Patients in gentamicin group received gentamicin solution for washing in the operation.All the patients undergoing operation were followed up for 2 weeks after operation.Diagnosis of postoperative infection was based on clinical manifestations.Results A total of 109 patients received operation in all the 116 cases,including 58 cases in gentamicin group and 51 cases in control group.Thirteen cases of postoperative infection were identified in all the patients receiving operation (11.93%),3 cases in gentamicin group and 10 in control group.The incidence of postoperative infection was significantly different between the two groups (X~2= 5.3342,P=0.0209).Eight cases had positive bacterial culture.Of the microbiological isolates,2 were gram-positive bacteria, 5 gram-negative bacteria and 1 Candida albicans.Conclusions The most common pathogen causing postoperative infection after transurethral ureteroscopic lithotripsy is gram-negative bacteria.The use of gentamicin solution for washing in the operation can reduce the incidence of postoperative infection.
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Objective To discuss the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) for residual or recurrent stones in the kidney or upper ureter after open surgery.Methods A total of 46 cases of residual or recurrent stones in the kidney or upper ureter after open surgery were included in the study.A pigtail catheter was inserted into the ureter transurethrally under ureteroscope to create an artificial hydronephrosis.Then a renal fistulization,usually on middle or upper calyx,was made.The stones were identified under ureteroscope,fragmented with a pneumatic ballistic lithotriptor,and extracted by using a grasping forceps.The renal fistulization tube was indwelled for drainage.Results The stones were completely removed on one session in 20 cases(43.4%),on two sessions in 15 cases(32.6%),and three in 8 cases(17.3%).Residual stones were seen in 3 cases(6.5%),with a size of 0.1 cm ? 0.1 cm ? 0.2 cm ～ 0.5 cm ? 0.5 cm ? 0.6 cm.Stones were removed through one working channel in 18 cases(39.1%),two channels in 20 cases(43.5%),and three channels in 8(17.4%).Conclusions The MPCNL is miuimally invasive and effective in the treatment of residual or recurrent stones after open surgery.
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Objective To evaluate the clinical signifi ca nce of retroperitoneoscopic ureterolithotomy for upper ureteral calculi. Methods Retroperitoneoscopic ureterolithotomy was carried out in 22 p atients with upper ureteral calculi. The operation was performed in the retroper itoneal space. After the upper ureter and calculi were exposed, a scalpel was ut ilized to cut the ureter longitudinally for the removal of calculi. A double-J t ube was inserted into the ureter routinely and the ureterotomy closure was perfo rmed with sutures. Results A conversion to open surgery was needed in 1 patient because the calculi had moved into the kidney. One patient e xperienced urinary leakage at 500～800 ml/d postoperatively, and received an ope n surgery of double-J tube insertion 3 days later. Of the remaining 20 patients, the procedure was successfully accomplished, with the operation time of 50~240 min (mean, 110 min) and the blood loss of 30~100 ml (mean, 50 ml). The time to t he recovery of intestinal functions was 12~30 h (mean, 18 h).The postoperative h ospital stay was 5~8 days (mean, 6.8 days). Follow-up with B-ultrasonography and intravenous urethrography for 1~12 months in the 20 patients found no residual calculi or ureteral stricture. Hydronephrosis disappeared in 15 patients and mil d hydronephrosis was detected in the rest of 5 patients. Conclusions Retroperitoneoscopic ureterolithotomy is a safe and effective option for upper ureteral calculi. It may be considered as the first-line treatment for re latively large-sized upper ureteral calculi.
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Objective To evaluate the efficacy and safety of percutaneous nephroscopic lithotripsy for the treatment of bilateral upper urinary calculi. Methods From July 2004 to December 2008,we performed percutaneous nephroscopic lithotripsy under X-ray or ultrasonic guidance for 35 patients with bilateral upper urinary calculi. Of the 35 patients,bilateral renal calculi were found in 18 patients,unilateral renal and unilateral ureteral calculus in 10,bilateral ureteral calculi in 7. Results In 35 patients (70 sides),the calculi was removed through a single tract in 49 sides,through double tracts in 18 sides,and through triple tracts in 3 sides. The mean operation time for unilateral PCNL was 66 min (ranged from 20 to 185 min). The stone-free rate was 80% (56/70) on one session. A second-look stone removal was needed in 8 laterals,and 3 laterals underwent three times of lithotomy. In three sides,a few residual renal stones were found after the first operation,but no second operation was performed. The final stone-free rate was 91.4% (64/70) in all of the cases,among which the stone-free rate was 100% (24/24) for ureteral stones and was 87% (40/46) for renal stones. In this series,no chest or abdominal injuries,intestinal perforation,or injuries to surrounding organs were detected. The patients were discharged from hospital in 5 to 30 days,and then were followed up for 3 to 6 months. During the follow-up,B-ultrasonography and KUB+IVP found no recurrence of calculi. Conclusions Percutaneous nephrolithotomy is effective and safe for bilateral upper urinary calculi. By skilled urologists in conditioned hospital,simultaneous bilateral percutaneous nephrolithotomy performed on bilateral upper urinary calculi can shorten the cycle time of treatment and hospitalization.