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【Objective】 To investigate the common etiology, characteristics and treatment of iatrogenic ureteral stricture. 【Methods】 The clinical data of 226 patients with ureteral stricture repaired during May 2019 and Mar. 2022 were retrospectively analyzed, including 68 cases of iatrogenic ureteral stricture. According to the etiology, the patients were divided into urinary group and non-urinary group. 【Results】 There were 42 females and 26 males, aged 25 to 67 (average 49.0±10.4) years. Upper ureteral stricture was detected in 24 (35.3%) cases, who received oral mucosal repair of the ureter. Middle ureteral stricture was detected in 12 (17.6%) cases, who underwent ileal ureterography. Lower ureteral stricture was observed in 24 (35.3%) cases, who were treated with vesical wall flap ureteroplasty. Full-length stricture was observed in 8 (11.8%) cases,who were treated with ileal ureterography. There were significant differences in age, gender, stenosis side, stenosis location and length, surgical methods and types between patients in the urinary group and non-urinary group (P<0.05). During the follow-up of 8 to 20 (average 12.3±5.6) months, the symptoms and renal function of all patients improved, and no recurrence occurred. 【Conclusion】 Invasive endourological surgery is the most common cause of iatrogenic ureteral stenosis. Different treatment strategies should be adopted according to patients’ condition, time of diagnosis and location and length of ureteral injury.
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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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PURPOSE@#To investigate the clinical value of urine interleukin-18 (IL-8), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for the early diagnosis of acute kidney injury (AKI) in patients with ureteroscopic lithotripsy (URL) related urosepsis.@*METHODS@#A retrospective study was carried out in 157 patients with urosepsis after URL. The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8, NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0, 4, 12, 24 and 48 h after the surgery. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.@*RESULTS@#The level of urine IL-8, NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4, 12, 24 and 48 h (p < 0.01). The ROC analysis showed the combined detection of urine IL-8, NGAL and KIM-1 at 12 h had a larger area under curve (AUC) than a single marker (0.997, 95% CI: 0.991-0.998), and the sensitivity and specificity were 98.2% and 96.7%, respectively. Pearson correlation analysis showed that the levels of urine NGAL at 4, 12, 24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18 (p < 0.01).@*CONCLUSION@#AKI could be quickly recognized by the elevated level of urine IL-8, NGAL and KIM-1 in patients with URL-related urosepsis. Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance, which may be an important reference for the early diagnosis of AKI.
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Humans , Acute Kidney Injury/etiology , Biomarkers , Early Diagnosis , Hepatitis A Virus Cellular Receptor 1 , Interleukin-18 , Interleukin-8 , Lipocalin-2 , Lithotripsy , Retrospective Studies , UreteroscopyABSTRACT
Objective:To explore the effects of retroperitoneal laparoscopic ureterolithotomy (RLU) and urethral ureteroscopic lithotripsy (URL) on renal function, oxidative stress, and immunoglobulin levels in patients with upper ureteral calculi.Methods:The clinical data of 78 patients with upper ureteral calculi, who received treatment in Yiwu Central Hospital from June 2017 to April 2020, were collected for this study. The patients were divided into URL group ( n = 38, URL treatment) and RLU group ( n = 40, RLU treatment) according to different surgical methods. Renal function (creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin), oxidative stress (superoxide dismutase, malondialdehyde), immunoglobulin (Ig) (IgA, IgM, IgG), and complications were compared between the two groups. Results:At 1 day after surgery, creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin in the RLU group were (79.59 ± 6.02) μmol/L,(6.93±1.17) mmol/L,(4.78±0.61) μg/L, respectively, which were significantly lower than those in the URL group [(86.98 ± 8.27) μmol/L, (7.62 ± 1.24) mmol/L, (6.03 ± 0.79) μg/L, t = 4.53, 2.53, 7.85, P < 0.001, P = 0.014, P < 0.001). At 1 day after surgery, IgA, IgM, and IgG in the RLU group were (1.94 ± 0.25) g/L, (1.55 ± 0.24) g/L, (6.59 ± 1.25) g/L, respectively, which were significantly lower than those in the URL group [(2.38 ± 0.23) g/L, (1.82 ± 0.27) g/L, (7.89 ± 1.36) g/L, t = 8.08, 4.67, 4.40, P < 0.001, 0.001, 0.001]. At 1 day after surgery, malondialdehyde level was significantly lower in the RLU group than in the URL group [(7.49 ± 1.26) mmol/L vs. (8.93 ± 1.38) mmol/L, t = 4.817, P < 0.001]. At 1 day after surgery, superoxide dismutase level was significantly higher in the RLU group than in the URL group [(72.18 ± 7.55) mg/L vs. (63.49 ± 6.69) mg/L, t = 5.37, P < 0.001). There was no significant difference in the incidence of postoperative complications [15.79% (6/38) vs. 7.50% (3/40), χ2 = 1.31, P = 0.252]. Conclusion:RLU for the treatment of upper ureteral calculi has fewer effects on renal function, oxidative stress, and immunoglobulin level in patients with upper ureteral calculi compared with URL and does not increase the incidence of complications.
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OBJECTIVE@#To verify the efficacy of transcutaneous electrical acupoint stimulation (TEAS) on catheter related bladder discomfort after ureteroscopic lithotripsy.@*METHODS@#Sixty male patients with selective ureteroscopic lithotripsy under general anesthesia were randomly divided into a TEAS group (30 cases, one case dropped off) and a sham TEAS group (30 cases, 2 cases dropped off). Before anesthesia induction, the patients in the TEAS group were treated with TEAS at Guanyuan (CV 4), Zhongji (CV 3), Zusanli (ST 36) and Sanyinjiao (SP 6) for 30 min, with disperse-dense wave, frequency of 2 Hz/ 15 Hz and current intensity of 6 to 10 mA. The patients in the sham TEAS group were treated with the same TEAS device at the same acupoints, but no electrical stimulation was given. After 30 min, anesthesia induction started. The total dosages of propofol and remifentanil in the two groups were recorded, and the time of operation and anesthesia, the time of wake-up and the time of stay in postanesthesia care unit (PACU) were recorded. The postoperative recovery was evaluated 5 min (T) after wake-up, 1 h (T), 2 h (T) and 6 h (T) after the operation, including the severity of urinary tract irritation and visual analogue scale (VAS) score. The occurrence of adverse reactions was observed, such as nausea and vomiting, dizziness and headache.@*RESULTS@#The dosage of remifentanil in the TEAS group was significantly lower than that in the sham TEAS group (0.05). Compared with the sham TEAS group, the incidence of more-than-moderate urinary tract irritation symptoms in the TEAS group was reduced (<0.05), and the VAS scores 1 and 2 h after operation were reduced (<0.05).@*CONCLUSION@#The 30-min TEAS at Guanyuan (CV 4), Zhongji (CV 3), Zusanli (ST 36) and Sanyinjiao (SP 6) before anesthesia induction could significantly control the severity of postoperative urinary tract irritation in patients with ureteroscopic lithotripsy, reduce the dosage of anesthetic drugs and relieve postoperative pain.
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Objective@#To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score) renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL).@*Methods@#Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university, including 75 males and 29 females. Age 20-75 (47.79±13.21) years. BMI 18.2-38.3 (24.4±3.7) kg/m2; Crushed stone site: left 56 cases, right 48 cases. There were 23 cases of renal inferior calyces calculi, 81 cases of non-inferior calyces calculi, and 19 cases of renal inferior calyces calculi with IPA<45°; American Society of Anesthesiology (ASA) scores: 65 cases of grade Ⅰ, 39 cases of grade Ⅱ; There were 71 patients with urinary tract infection before operation. There were 6 cases of renal puncture fistula before operation. Preoperative indwelling ureteral stent in 26 cases; There were 32 cases with history of extracorporeal shock wave lithotripsy. There were 27 patients with a history of urolithiasis therapy. The same physician used preoperative urinary CT+ 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate. RUSS renal stone scoring system was used to score the stones of patients before operation, and the relationship between the scores and the stones free rate was analyzed. The RUSS renal stone scoring system was supplemented and improved by including staghorn stone, duplicate renal, caliceal diverticulum, renal malrotation, stone area, and CT value related indexes. The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients, and the relationship between the score and the stone free rate was analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS, the characteristics of the stones, and RUSS system.@*Results@#The stone free rate was 69.2% (72/104) 4 weeks after the operation, and there were no postoperative complications. Single-factor analysis showed that stone area, CT value, number of renal calyx involved by stone, multiple stones, IPA, stone size grading, renal anatomic structure abnormality, staghorn stone were all related risk factors affecting postoperative patients. Multi-factor analysis showed that stone area, number of renal calyces involved by stone, multiple stones, IPA and stone size were independent risk factors affecting the stone free rate after FURL. RUSS scores ranged from 0 to 3 points, corresponding to stone clearing rates of 86.8% (33/38), 67.7% (23/34), 58.3% (14/24) and 25.0% (2/8), respectively. Stone clearing rates were significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (0.87±0.96) points and (1.53±0.98) points, respectively, with significant differences between the groups (P<0.05). The range of modified RUSS score was 0-4 points, corresponding to the stone clearing rate of 100.0% (25/25), 92.3% (24/26), 54.2% (13/24), 47.4% (9/19), and 10.0% (1/10), respectively. Stone free rate was significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (1.15±1.13) points and (2.81±0.93) points, respectively, with significant differences between the groups (P<0.05). The AUC of stone features was smaller than that of the modified RUSS scoring system. The AUC of RUSS scoring system (0.707, 95%CI 0.598-0.815) was smaller than that of the modified RUSS scoring system (0.865, 95%CI 0.797-0.933).@*Conclusions@#Both the RUSS scoring system and the modified RUSS scoring system could accurately predict the postoperative stone free status of FURL, while the modified RUSS scoring was more accurate than the RUSS scoring.
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Objective To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score)renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL).Methods Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university,including 75 males and 29 females.Age 20-75 (47.79 ± 13.21) years.BMI 18.2-38.3 (24.4 ± 3.7) kg/m2;Crushed stone site:left 56 cases,right 48 cases.There were 23 cases of renal inferior calyces calculi,81 cases of non-inferior calyces calculi,and 19 cases of renal inferior calyces calculi with IPA ＜ 45°;American Society of Anesthesiology (ASA) scores:65 cases of grade Ⅰ,39 cases of grade Ⅱ;There were 71 patients with urinary tract infection before operation.There were 6 cases of renal puncture fistula before operation.Preoperative indwelling ureteral stent in 26 cases;There were 32 cases with history of extracorporeal shock wave lithotripsy.There were 27 patients with a history of urolithiasis therapy.The same physician used preoperative urinary CT + 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate.RUSS renal stone scoring system was used to score the stones of patients before operation,and the relationship between the scores and the stones free rate was analyzed.The RUSS renal stone scoring system was supplemented and improved by including staghorn stone,duplicate renal,caliceal diverticulum,renal malrotation,stone area,and CT value related indexes.The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients,and the relationship between the score and the stone free rate was analyzed.The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS,the characteristics of the stones,and RUSS system.Results The stone free rate was 69.2％ (72/104) 4 weeks after the operation,and there were no postoperative complications.Single-factor analysis showed that stone area,CT value,number of renal calyx involved by stone,multiple stones,IPA,stone size grading,renal anatomic structure abnormality,staghorn stone were all related risk factors affecting postoperative patients.Multi-factor analysis showed that stone area,number of renal calyces involved by stone,multiple stones,IPA and stone size were independent risk factors affecting the stone free rate after FURL.RUSS scores ranged from 0 to 3 points,corresponding to stone clearing rates of 86.8％ (33/38),67.7％ (23/34),58.3％ (14/24) and 25.0％ (2/8),respectively.Stone clearing rates were significantly correlated with stone grading (P ＜ 0.05).The total scores of stone free group and residual stone group were (0.87 ± 0.96) points and (1.53 ± 0.98) points,respectively,with significant differences between the groups (P ＜ 0.05).The range of modified RUSS score was 0-4 points,corresponding to the stone clearing rate of 100.0％ (25/25),92.3％ (24/26),54.2％ (13/24),47.4％ (9/19),and 10.0％ (1/10),respectively.Stone free rate was significantly correlated with stone grading (P ＜ 0.05).The total scores of stone free group and residual stone group were (1.15 ± 1.13) points and (2.81 ± 0.93) points,respectively,with significant differences between the groups (P ＜ 0.05).The AUC of stone features was smaller than that of the modified RUSS scoring system.The AUC of RUSS scoring system (0.707,95 ％ CI 0.598-0.815) was smaller than that of the modified RUSS scoring system (0.865,95％ CI 0.797-0.933).Conclusions Both the RUSS scoring system and the modified RUSS scoring system could accurately predict the postoperative stone free status of FURL,while the modified RUSS scoring was more accurate than the RUSS scoring.
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Objective To compare the effect, postoperative inflammatory response, stress response differences of percutaneous nephrolithotomy ( PCNL) and flexible ureteroscopic lithotripsy ( FURL) in the treatment of renal calculus with a diameter ≤2 cm. Methods One hundred and twenty-eight patients with renal calculus ≤2 cm m in Beijing Pinggu Hospital were enrolled in the study and were randomly divided into PCNL group( 64 cases ) and FURL group ( 64 cases ) . The treatment of PCNL and FURL was carried out respectively. The stone clearance rate,operation time,hospitalization time,the number of painkillers used after surgery,inflammatory index ( hs-CRP,IL-6),oxidative stress index ( MDA,SOD) were compared. Results There was no significant difference in the stone clearance rate between PCNL group and FURL group ( χ2= 0. 208,P>0. 05). The operation time of PCNL group was (55. 32±5. 80) min,which was shorter than that of FURL group ((65. 21± 4. 24) min), the difference was statistically significant ( t = 16. 322,P< 0. 01) . The hospitalization time of FURL group was (4. 50±1. 20) d,which was shorter than that of FURL group ((7. 40 ±1. 80)),the difference was statistically significant (t= 9. 441,P<0. 01). The number of painkillers used after surgery in the FURL group was (0. 35±0. 14) times,which was less than that in FURL group ((0. 85±0. 24) times),the difference was statistically significant ( t = 8. 625,P < 0. 01) . The postoperative hs-CRP of FURL group (10. 62±1. 26) mg was significantly lower than that in PCNL group (19. 42±1. 35) mg/ L,The difference was statistically significant (t= 12. 734,P<0. 01) . The postoperative IL-6 of FURL group was(31. 50±6. 57) ng/ L,significantly lower than the PCNL group(38. 72±6. 25) ng/ L,the difference was statistically significant (t= 5. 839,P<0. 01). The postoperative MDA of FURL group (0. 63±0. 17) mmol/ L was significantly lower than that of the PCNL group (0. 80±0. 20) mmol/ L,The difference was statistically significant (t= 4. 288,P<0. 01) . The postoperative SOD of FURL group (80. 40± 5. 80) U/ L was significantly higher than the PCNL group (74. 30± 7. 40) U/ L, the difference was statistically significant ( t = 4. 691, P <0. 01). The incidence of postoperative complications in PCNL group was 10. 94% ( 7/ 64), FURL group was 2. 17% ( 1/ 64), the difference was statistically significant (χ2 = 4. 800,P<0. 01). Conclusion FURL has the characteristics of less intraoperative blood loss,less trauma,less postoperative pain and fewer complications in the treatment of renal calculus ≤ 2 cm, which has less smaller inflammation, oxidative stress, and conducive to the patients' postoperative recovery.
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Objective To investigate the intracavitary surgical therapy and efficacy for the patients with duplex kidney and ureter with upper urinary tract calculi. Methods The clinical data of twenty-six cases with duplex kidney and ureter with upper urinary tract calculi were retrospectively analyzed. Results Of 26 patients who underwent intracavitary surgical treatment, 5 patients were treated by ureteroscopic lithotripsy (URL), 15 by retrograde intrarenal surgery (RIRS), 6 by mini-percutaneous nephrolithotomy (mPCNL). All 26 cases were performed successfully. No severe complications such as septic shock, heavy blood loss, ureter injury, and pneumothorax occurred. 23 patients with nephrohydrosis were followed up for 2 to 24 months and most of them improved at different extents. Conclusion The current technique of intracavitary surgery in the management of duplex kidney and ureter concomitant with upper urinary tract calculi, has the advantages of less trauma, rapid recovery, safety and so on.
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Objective To investigate the 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 propose ex vivo ureteroscopy (ExURS) and technical modification to render the donated kidney stone-free at live donor renal transplantation.Methods A suitable kidney donor with small unilateral nonobstructive calculi in the lower calyx of left kidney underwent laparoscopic live donor nephrectomy. After cold perfusion, ExURS was performed immediately in an iced saline solution. A F8.0/9.8 semirigid ureteroscope was accessed to collecting system via the ureteral stump. A 'Pull-up'skill was applied in order to facilitate the atraumatic access to the pelvis. The harvested kidney was rotated so as to facilitate the semirigid ureteroscope access to the lower calyx. The calculi was then completely endoscopic fragmented with holmium and removed. Results The warm ischemia time was 3 min and the cold ischemia time was 2.5 h. The procedure time was 18 min. There were no intra-operative or postoperative ureteral complications. The urine volume of recipient was 6260 ml in the postoperative day. the serum creatinine of 1 to 4 postoperative days were 402 μmol/L, 186 μmol/L, 136 μmol/L, 112 μmol/L, respectively, which was normal 4 days after operation. The serum creatinine maintain at 100 μmol/L approximately, in 6 months follow up.Conclusions ExURS is a technically feasible means of rendering a stone bearing donor kidney stone-free safely and efficiency.
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Objective To compare the efficacy of ureteroscopic lithotripsy(URL)combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper incarcerated ureteral stones. No difference could be found in age,sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital,all cases of upper incarcerated ureteral stones were diviede into two groups:52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva-sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were(5.5 ± 1.4)days and(53.3 ± 12.4)mins,which were significantly shorter than that in mPCNL group with(9.1 ± 3.2)days and(78.2 ± 14.1)mins,(P 0.05),stone clearance rate(100% vs 91.8,P > 0.05)and complication rate (4.4%vs 3.9%,P>0.05). Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.
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Objective To investigate the effects of flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for treating renal pelvis calculus.Methods The clinical diagnosis and treatment data in 65 patients with single renal pelvis calculus treated in department of urology surgery of our hospital from Jan.2013 to Jan.2016.Among them,33 casesas the group A adopted flexible ureteroscopic lithotripsy and 32 cases as the group B adopted percutaneous nephrolithotomy.The operative time,lithotripsy success rate,complications and average hospitalization time were compared between the two groups.Results In the renal pelvis calculus diameter ≥ 2 cm,the operation time and lithotripsy success rate in the group B were significantly better than those in the group A,but the intraoperative blood loss and average hospitalization time in the group A were significantly better than those in the group B,the differences were statistically significant (P＜0.05).In renal pelvis calculus diameter ≤2 cm,the lithotripsy successful rate had no statistically significant difference between the two groups (P＞0.05),but the group A was significantly better than the group B in the operative time,intraoperative blood loss and average hospitalization time (P＜0.05).Conclusion Renal pelvis calculus diameter ＜2 cm is suitable for selecting flexible ureteroscopic lithotripsy,but which ≥2 cm is suitable to select percutaneous nephrolithotomy.
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Objective To systematically review the efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in management of lower pole kidney stones.Methods PubMed, Embase, Scopus, Cochrane library, CNKI, VIP and Wanfang Data were searched from the beginning of database to September 2016 and clinical trials that compared the two above operation for treatment of lower pole stones were collected.Two researchers independently filtered literature,extracted data and evaluated the methodological quality of research papers.The meta-analysis was performed using the RevMan 5.3 software.Results One randomized and seven non-randomized studies were analyzed, which consists of 621 patients including MPCNL group 327 cases, FURL group 294 cases.The results of meta-analysis showed that MPCNL was better than FURL in stones clearance (OR =2.65,95％ CI 1.58-4.46,P ＜ 0.01) and operative time (WMD =-21.86,95％ CI-28.52--15.20, P ＜ 0.01).FURL was better in hospital stay time (WMD =2.28,95％ CI 0.29-4.28, P =0.02), decrease in haemoglobin levels (WMD =0.78,95 ％ CI 0.68-0.89, P ＜ 0.01), bleeding (OR =5.11,95 ％ CI 1.12-23.31,P =0.04), transfusion(OR =7.04,95％ CI 1.59-31.15, P =0.01).There was no significant difference in fever,urinary tract infection, hematuria (P ＞ 0.05).Conclusions Both MPCN and FURL are safe and effective for the treatment of lower pole stones, MPCNL can get higher stone clearance rates and shorter operation time.However, FURL can get shorter hospitalization time and lower complication rates.
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Objective To investigate the clinical efficacy of flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy treating for partial staghorn calculi.Methods 84 patients diagnosed as partial staghorn calculi in our hospital were randomly divided into group A and B with each group 42 patients.Patients in group A received the conventional minimally invasive percutaneous nephrolithotomy in the prone position,and patients in group B received the percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in the modified Valdivia position.The post-operative stone free rate and complications were recorded.Results The surgery time in group B was longer than that in group A [(106.44±18.46)min vs(83.69±10.29)min],with statistically significant difference(P38.5℃),but there was no notably difference between the two group(P>0.05).Conclusion Compared with the regular percutaneous nephrolithotomy,flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy treating partial staghorn calculi has the shorter operation time,the less blood volume and the higher first stone free rate.Furthermore,the combination method did not significantly increasing the incidence of patient's complication.
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Objective To study the combination treatment of lfexible/lfexible sheath and rigid ureteroscopic lithotripsy (F-ul) for upper and middle ureteral stones. Methods The clinical data of patients diagnosed of upper and middle ureteral stones were collected. The treated group (110 cases):ifrstly treated with rigid ureteroscopic lithotripsy to broke and removed stones through lfexible sheath, then the lfexible ureteroscopic lithotripsy was used to broke and removed stones through lfexible sheath;The control group (110 cases):traditional operation for ureter calculi. The clinical data was compared between the two groups. Results The effective ratio of treatment group is 90.0%, which was better than that of control group (87.3%) (P>0.05). The operation time, stone processing time of treatment group were signiifcantly shorter than those of control group (P 0.05). Conclusion The method of combining flexible/flexible sheath and rigid ureteroscopic lithotripsy for upper and middle ureteral stones was better than that of traditional operation, which worth to be popularize in clincal treatment.
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Objective To compare the effect and safety of digital flexible ureteroscopic lithotripsy and per-cutaneous nephrolithotomy for renal calculi. Methods Clinic data of 105 cases with kidney stones were analyzed retrospectively, including 53 cases with digital flexible ureteroscopic lithotripsy (group A) and 52 with minimally invasive percutaneous nephrolithotomy (group B). The operative time, intraoperative blood loss, stone-free rate, complications, average hospitalization time were compared. Results There were no significant differences in age, gender, stone size, stone surface area, average operative time, stone-free rate and complications between two groups. Significant differences were found between group A and group B in terms of intraoperative blood loss and average hospitalization time. Conclusions Digital flexible ureteroscopic lithotripsy has similar effect as minimally invasive percutaneous nephrolithotomy for the treatment of kidney stones about 20 mm in terms of average operative time, stone-free rate, and complications, but excels minimally invasive percutaneous nephrolithotomy in intraopera-tive blood loss and average hospitalization time. Digital flexible ureteroscopic lithotripsy can be the first choice for the treatment of kidney stones about 20 mm.
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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 investigate the efficacy of tamsulosin in the distal ureter calculi expelling after ureteroscopic lithotripsy. Methods A total of 120 patients with distal ureteral calculi were enrolled and randomly divided into the observation group and the control group with 60 patients in each group. Patients in the observation group received tamsulosin and traditional treatment ( including liquid impact therapy,anti-inflammatory and analgesia) ,while patients in the control group received placebo and traditional treatment after operation. The number of colic episodes,lower urinary tract symptoms,analgesic dosage,and time of calculus removing were recorded and all the data were statistically analysed through software SPSS 13. 0. Results There was no singinificant difference between the two groups in the rate of calculus removing (P>0. 05), but it took less time in the observation group (P<0. 05). In addition, it was of less low urinary tract symptoms, low-er rate of analgesic usage and colic episodes in the observation group with statistically significant differences compared with the control group (P<0. 05). Conclusion The application of tamsulosin after ureteroscopic lithotripsy can reduce the rate of colic episodes and analgesic dosage and time of calculus removing.
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PURPOSE: Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. MATERIALS AND METHODS: This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. RESULTS: The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. CONCLUSION: Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.