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Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure.Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years'experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018.Of all the 58 patients,there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years.The calculi ranged from 9 mm to 93 mm,with the average of 26.5 mm.The separation of renal collecting system ranged from 5 mm to 30 mm,with the average of 15.1 mm.All of the 58 patients underwent one-stage PCNL and the numbers of punctures,the numbers of percutaneous tubes and the reasons for failure were recorded.Results All percutaneous tubes and surgeries were established and done successfully.Of all the 118 punctures,74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation).The total puncture success rate was 62.7％ (74/118).Of the total 74 successful punctures,56.8％ (42/74) succeeded at the first puncture,28.4％ (21/74)succeeded at the second puncture and 14.9％ (11/74)succeeded at least after three punctures.The success puncture rate of the 4 urologists were 59.2％ (29/49),64.1％ (25/39),66.7％ (16/24),66.7％ (4/6)respectively,and there were no statistical differences between the puncture success rates of the urologists (P =0.679).Each channel needed 1.7 punctures on average.Fouty-four punctures failed without detecting the urine,including 20 failed punctures because of the puncture tract deviation,17 punctures without seeing the urine after the core needle being removed,7 punctures no display on the ultrasound imagine.There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes.Five nephrostomy tubes'position were different with the preoperationally predicted position which means the discrepancy rate was 14.3％ (5/35).One patient had complications and classified as Grade Ⅱ or above on the modified Clavien Grading System of aerothorax.Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied.The main reasons of puncture failure are the deviation of puncture tract,unclear imaging of puncture tract and other unclear reasons (puncture needle went too deep or superficially or tip of the needle embedded into the stone).
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Objective@#To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure.@*Methods@#A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded.@*Results@#All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax.@*Conclusions@#The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone).
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Objective To discuss primary experience the clinical use of "All-seeing needle set" combined with Holmium laser to treat the single renal stone lesser than 2 cm in diameter through a super minimal tract (F12).Methods From January 2015 to December 2016,43 patients were enrolled into this retrospective study.There were 23 males and 20 females who were diagnosed as single renal stone less than 2 cm in diameter(age range from 23-65 years).There were 8 upper pole renal stones,13 lower pole renal stones and 22 renal pelvis stones.The mean stone size was (1.63 ± 0.32) cm in diameter (range from 1.2 cm to 2.0 cm)."All-seeing needle system" was applied during percutaneous puncture.After building a F12 minimal tract by fascia dilator,all patients received lithotripsy with Holmium laser.Indwelling catheters for 3 days and an F6 double-J tube was left for 2 weeks without a tube in the percutaneous tract after operation.Finally,KUB and/or urinary CT were used to check the results on day 1.Result All operations were completed successfully.The operation time was 23-65min [averaged (31.0 ±9.2) min].41 cases' renal stones were store free,and the 2 stone residues was clear with later extracorporeal shock wave lithotripsy.No severe complications occurred.Conclusion As an alternative to standard procedures for treatment of renal stones less than 2 cm in diameter,adopting "All-seeing needle set" with Holmium laser through a super minimal tract (F12) is safe,minimally invasive,fast and effective with a low complication rate.
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Objective To evaluate the safety and efficacy of retrograde flexible ureteroscopy combined with visual minimally channel percutaneous nephrolithotomy ( mPCNL) in the treatment of staghorn calculi.Methods A total of 23 patients with staghorn calculi were treated by retrograde flexible ureteroscopy combined with visual mPCNL from January to June, 2015.Of all the 23 patients, 20 were males and 10 were females ( ages ranged from 26 years to 79 years ) with mean age of 39.6 years.The calculi ranged from 3.5 cm to 6.5 cm [average (5.35 ±0.16) cm].Under general anesthesia or epidural anesthesia, the stones were shattered within the visual field through mPCNL firstly, then the stones in upper calyx, lower calyx and/or calyx which parallel with the percutaneous renal access were shattered by retrograde flexible ureteroscopy.F5 or F6 double-J tubes and nephrostomy tubes were routinely indwelled postoperatively.KUB and CT were performed at the first day postoperatively.A second-stage retrograde flexible ureteroscopy combined with visual mPCNL were performed for patients with residual stone fragments larger than 4 mm at the first week follow-up.Re-examinations with B-ultrasonography or CT was performed at the fourth week follow-up postoperatively to evaluate the stone free rate.Residual stones ≥ 4 mm were considered as clinical significance of residual stone.Results All the procedures were successful.The stone free rate was 91.3%(21/23) at one-stage and 100% (23/23) after the second stage.The operation time was 75-217 min [average (125 ±13.2) min] for one-stage procedure.Seven patients experienced with mild complications ( Clavien-Dindo classification: gradeⅠ-Ⅱ) , and no patient experienced grade Ⅲ or above complications.Conclusions Retrograde flexible ureteroscopy combined with visual mPCNL are safe and effective for the treatment of staghorn calculi.
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Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser litho-tripsy on the treatment for upper ureteral calculi of solitary kiden. Methods There were 26 cases of upper ureteral calculi of solitary kidney, including 12 cases of left ureter calculi and 14 cases of right ureter calculi. The diameter of the calculi ranged from 0. 6~2. 2 cm, averagely (1. 38 ± 0. 22) cm. F6 double-J tubes were indwelled postoperatively for 4 weeks, and catheters were indwelled postoperatively for one week. Examine with KUB one day after operation to evaluate the effective rate. Results The Ureteral guiding sheath were successfully implanted in 23 cases, 2 cases underwent second lithotripsy after indwelling D-J tubes 2 weeks later, D-J tubes failed to be implanted only in one case, which has changed to percutaneous nephrolithotomy (PCNL) for ureter stricture. The stone free rates was 88. 5%(23/26)after the first ses-sion,and it was 100%(26/26)at the end of the session. The operation time was 15~45 min, meanly (27 ± 3. 2) min. One patient had ureter perforation during the operation, and one patient had severe infection after operation. Conclusion The modular flexible ureteroscopy com-bined with Holmium laser lithotripsy is an effective and safe treatment, especially for upper ureteral calculi of solitary kideny, and it should be considered as the first choice for solitary kidney calculi.
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Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser lithotripsy for treatment of renal calculi. MethodsA total of 46 patients with renal calculi were treated with modular flexible ureteroscope combined with Ho:YAG lithotripsy in our hospital from December 2009 to May 2011.There were 19 cases in middle and upper calyx,8 cases in lower calyx,15 case in renal pelvic,and 4 cases in multiple calyxes.The calculi diameter ranged from 6mm to 31 mm (average in 15 ± 7.9 mm).Flexible ureteroscope was used to find renal calculus under epidural anesthesia,and Holmium laser lithotripsy was used at a maximum energy of 12 to 20W (0.8 - 1.0 J/15 -20Hz).F5 or F6 double-J tubes and catheters were indwelled routinely postoperatively.-examine with KUB and removethe catheter 2 days after operation.Re-examine with B-ultrasonography or KUB 4 weeks after op-eration to evaluate the stone free rate.Residual stones ≥4 mm were regarded as clinical significance of residual stone fragments. Results 45 operations were successful except one case changed to percutaneous nephrolithotomy (PCNL) because of ureteral stricture.The operation time was 45 -150 min (average in 110.4 ±25.3 min).The patients were discharged from hospital in 2 -5 days(average in 3 days) after operation.The stone detection rate was 95.6％ (44/46),and the stone free rate was 86.9％ (40/46) after one operation. No severe complications such as ureteral perforation or hemorrhea occurred. Conclusions Modular flexible ureteroscope combined with Holmium laser lithotripsy is effective and safe for treatment ofrenal calculi,meanwhile it can decrease the high maintenance costs of integrated flexible ureteroscope.
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Objective To analyze the effects of flexible ureteroscopic Holmium laser lithotripsy on renal function in the treatmen of renal calculi. Methods From October 2010 to March 2012,41 cases of solitary renal calculi (24 males and 17 females) were treated with flexible ureteroscopic Holmium laser lithotripsy ( FURL).Patient's mean age was 51.9 ± 15.9 years ( range from 31 to 88 years).Locations of renal calculi detected by image study were 22 cases in middle and upper calyx,9 cases in lower calyx,10 case in renal pelvis.The mean size of calculi was 16.9 ±6.0 mm (range from 10 to 28 mm).Blood samples (2 h pre-operatively,and then 2 h,12 h,24 h,48 h,72 h post-operatively) were collected and serum NGAL,serum Cys-C were tested Results The measured levels of pre-operative NGAL and Cys-C were 3.5 ± 0.6μg/L,501.7±121.3 μg/L,and levels of post-operative NGAL at 2 h,12 h,24 h,48 h and 72 h were 4.2±0.8 μg/L,5.0±1.0 μg/L,4.9±1.4 μg/L,4.3± 1.1 μg/L and 3.8 ±0.1 μg/L,while the according levels of Cys-C were ( 516.4 ± 126.2 ) μg/L,( 723.8 ± 134.8 ) μg/L,( 770.4 ± 162.8 ) μg/L,(671.7 ± 138.3 ) μg/L and 574.0 ± 116.7 μg/L.Serum NGAL began to increase 2 hours after operation (P ＜0.05,and reached the peak in 12 hours,it began to decline 12 hours after surgery,but it was still higher at 72 hours than pre-operative level (P ＜ 0.05.Serum Cys-C showed no obvious ascent 2 hours after operation in FURL group ( P ＞ 0.05 ),but increased obviously 12 hours after operation and lowered down after the peak that occurred 24 hours after surgery.Serum Cys-C still remain above the baseline 72 hours after operation (P ＜0.05). Conclusions Flexible ureteroscope lithotripsy can cause reversible damage to renal function after surgery.