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This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.
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Humanos , Cálculos Ureterales/terapia , Cálculos Urinarios/terapia , Uréter , Litotricia/métodos , Edema/terapia , Cálculos Renales/terapiaRESUMEN
Objective To investigate the clinical effects and safety of spiral stone basket assisted with FURL in the treatment of unilateral upper ureteral stones for diameter>1.0 cm. Methods 140 patients with unilateral upper ureteral stones for diameter>1.0 cm from January 2012 to December 2015 were randomly divided into control group (70 patients) with FURL used alone and observation group (70 patients) with spiral stone basket assisted application on the basis of control group;the perioperative clinical indicators, the lithotripsy success rate, the stone clearance rate, the stone removal rate and the postoperative complication incidence of both groups were compared. Results The operation time of observation group was signiifcantly longer than control group (P0.05). The lithotripsy success rate and the stone clearance rate of observation group was signiifcantly higher than control group (P 0.05). The total treatment expenses of observation group was signiifcantly fewer than control group (P1.0 cm can efifciently higher the stone removal effects, reduce the stone removal risk and not increase the postoperative complications incidence.
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Resumen: Introducción: el desarrollo de técnicas de mínimo acceso en el tratamiento de litiasis urinaria ha modificado el manejo de esta patología en la actualidad; sin embargo, el desafío terapéutico continúa siendo grande en pacientes con cálculos complejos del uréter proximal y pelvis renal, donde una buena opción es la cirugía laparoscópica. Materiales y métodos: fueron tratados mediante cirugía laparoscópica 10 pacientes durante el primer semestre del año 2016, portadores de litiasis piélica compleja y de uréter proximal (> 15 mm); edad: 38 años (±11.66). Localización de los cálculos: 8 en el uréter proximal y 2 en la pelvis renal. Resultados: tiempo operatorio: 65 a 270 minutos; pérdida de sangre media: 31.25 ml (± 6.29), producción del dren en el primer día: 36 a 45 ml. Dolor postoperatorio en el primer día postquirúrgico: 3.5 (EVA) (± 2.22). El resultado cosmético fue muy satisfactorio para todos (media: 9.5 ± 0.05). Tasa libre de litiasis: 100%. Discusión: el manejo de los cálculos ubicados en el uréter proximal, cuando son voluminosos o piélicos complejos, son un desafío debido a su menor tasa libre cálculos ya sea con ureterorrenoscopia o litotripcia extracorpórea; una opción para el tratamiento de este tipo de litiasis es la cirugía laparoscópica (tasa libre de cálculos hasta 100% en una sola sesión) y mejoría de los parámetros como estancia hospitalaria, requerimiento de tratamiento analgésico adicional, recuperación y resultados cosméticos. Conclusiones: los cálculos de volumen considerable o situados en una parte del aparato urinario de difícil acceso se tratan con éxito a través del abordaje laparoscópico, que es una opción ideal que sustituye el abordaje abierto y métodos endourológicos en casos seleccionados. Palabras claves: ureterolitotomía laparoscópica, cálculo ureteral, cálculo piélico, ureterorrenoscopia, litotripcia extracorpórea
Introduction: The development of minimal access techniques in the treatment of urolithiasis has changed the management of this condition today; however the therapeutic challenge remains in patients with complex stones in proximal ureter and renal pelvis in which laparoscopic surgery is a good option. Materials and Methods: 10 patients were treated during the first half of 2016, whith diagnosis of complex pelvic lithiasis and proximal ureteral stones (> 15 mm); laparoscopic surgery was indicated. The mean age was 38 years (± 11.66). The location of these lithiasis was 8 proximal ureter and 2 in the renal pelvis. Results: Operative time ranged from 65 minutes to 270 minutes; the mean blood loss was 31.25 cc (± 6.29), drain production on the first day was between 36 ml - 45 ml. Postoperative pain on the first day after surgery was 3.5 (VAS) (± 2.22). The cosmetic result was very satisfactory for all, with an average of 9.5 (± 0.05). stone-free rate was 100%. Discussion: The management of bulky proximal ureteral stones or complex pyelic stones are a challenge because of its low stone-free rate either with ureterorenoscopy or external shock wave lithotripsy; an option for treating this type of stones is laparoscopic surgery, with a stone-free rate up to 100% in a single session and improving parameters such as hospital stay, requirement for additional analgesic treatment, early recovery, and cosmetic results. Conclusions: In complex situations ureteral or pyelic stones are successfully treated through laparoscopic approach, being an ideal choice to replace the open approach and endoruologic methods in selected cases. Key words: laparoscopic ureterolithotomy, ureteral stones, pyelic stones, ureterorenoscopy, shock wave lithotripsy.
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Humanos , Nefrolitiasis , Litotricia , UrolitiasisRESUMEN
Objective To compare the efficacy and safety of tamsulosin with nifedipine for medical expulsive therapy (MET) in patients with lower ureteral stones (LUS).Methods Randomized controlled trials(RCTs) in comparison of tamsulosin and nifedipine in treatment of LUS published in Pubmed, Cochrane Library,Embase,CNKI,CBM, Wanfang and VIP from databases establishment to July 2015 were retrieved.According to Cochrane handbook, the quality of included RCTs were assessed, and the relevant data including the number of participants, stone size, stone expulsion rate, time to stone expulsion, drug-related side effect,the incidence of ESWL or ureteroscopy lithotripsy (URSL) after MET and analgesic dose were extracted by two reviewers independently.The statistical software RevMan 5.2 was used for meta-analysis with regard to the stone expulsion rate, the incidence of ESWL or URSL and adverse effects.This study lasted more than one month from June to July 2015.Results A total of 13 RCTs with 4 831 patients were eligible.The results showed that the stone expulsion rate and the incidence rate of ESWL or URSL after MET were 92％ (2 221/2 423) and 8％ (27/333) in the tamsulosin group,and 73％ (1 748/2 408) and 20％ (67/328) in the nifedipine group.There are statistically significant differences (RR =1.24,95 ％ CI 1.13-1.37, P ＜ 0.05;RR =0.40,95 ％ CI 0.27-0.60, P ＜ 0.05, respectively).The subgroup analysis indicated no statistically significant differences in drug-related adverse effects between tamsulosin and nifedipine with 5％ (99/1 804)and 7％ (117/1 796) minor adverse effects respectively and less than 1％ severe adverse effects in both groups (RR =0.85,95％ CI 0.65-1.10, P =0.21;RR =0.49,95 ％ CI 0.09-2.59, P =0.40).Conclusion Compared to nifedipine, tamsulosin has higher stone expulsion rate and lower incidence rates for ESWL or URSL.Since there was no obvious adverse effects, tamsulosin could be considered as a preferable option for patients with LUS.
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Objective To investigate the clinical effect of non-steroidal anti-inflammatory drugs and αl-adrenergic antagonist on treating patients with ureteral stones.Methods A total of 128 patients with ureteral colic due to ureteral stones were randomly divided into control and treatment group,and 64 cases in each group.Both two groups were treated with tamsulosin 0.4 mg oral,intravenous injection of saline 1000 mL Patients in treatment group were received intramuscular non-steroidal anti-inflammatory drugs(10 mg) and patients in control group were received pethidine hydrochloride(10 mg).Ultrasound exam were performed after 6-8 h to evaluate the stone expulsive rate.Extracorporeal shock wave lithotripsy and other treatment were underwent when the stone was still not discharge.Results The effective rate of analgesia was 96.9％ (62/64) in treatment group and 100％ (64/64) in control group(x2 =2.03,P =0.50).The stone expulsion rate in treatment group was 28.1％ (18/64),higher than that in control group(12.5％ (8/64),x2 =4.83,P =0.05).Conclusion It is effective to relive ureteral cohc with non-steroidal anti-inflammatory drugs only,and it is better than pethidine in promote stone expulsion when they both used with α1-adrenergic antagonist.
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Objective To investigate the feasibility and safety of endoscopic treatment of ureteral calculi acute obstruction with urinary extravasation. Methods 56 patients with ureteral calculi acute obstruction and urinary extravasation were randomly divided into two groups:the treatment group and the control group,28 cases in each group. Patients in the treatment group were given URSL or percutaneous nephrostomy drainage, and the secondary fistula was given URSL stone clearance treatment. Patients in control group were given traditional ureterolithotomy treatment. The stone clearance rate, the average recovery time after surgery, postoperative wound infection rate and the abnormal rate of postoperative albumin were observed in two groups. Results In the treatment group,28 patients had no residual stones with mean postoperative recovery time of (5.2 1.3) days,postoperative fever was found in 3 cases,obvious abnormal postoperative albumin in 3 cases. In the control group,residual stones were found in 3 cases,the average recovery time after surgery was (7.9 2.6) days,postoperative fever was found in 10 cases, and obvious abnormal postoperative albumin in 11 cases. There were statistically significant differences in stone clearance rate, the average recovery time after surgery, postoperative wound infection rate and the abnormal rate of postoperative albumin between two groups (P<0.05) . Conclusion Endoscopic treatment of ureteral calculi acute obstruction and urinary extravasation has advantages including better efficacy, less trauma, less complications and quicker recovery.
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Objective To compare the effect of ureteroscopic pneumatic lithotripsy(URL) and extracorporeal shock wave lithotripsy(ESWL) for ureteral stones.Methods 90 patients with ureteral stones were randomly divided into group A( URL group),group B( ESWL group),each group 45 cases.The effect of surgical treatment was compared between the two groups.Results The one-time success rate of gravel,stone free after 4 weeks of A group was significantly higher than that of group B( x2 =9.680,5.414,all P ＜0.05),but there was no significant difference in the surgical time and hospital stay of the two groups( t =1.010,0.909,all P ＞ 0.05 ).The postoperative renal colic,fever and other complications of group A were significantly lower than that of group B ( x2 =6.049,5.075,all P ＜0.05),but the gross heraturia and ureteral injury of group A was higher than that of group B(x2 =5.874,3.873,all P ＜ 0.05 ).Conclusion The ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of ureteral stones all have good effect,but ureteroscopic pneumatic lithotripsy and stone rubble drain success rate are significantly higher than extracorporeal shock wave lithotripsy,and postoperative complications are relatively less than extracorporeal shock wave lithotripsy.
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Objective To compare the efficacy of the emergency ESWL within 24 hours after the onset of renal colic and elective ESWL at 5 - 7 days after the onset of renal colic in the treatment for ureteral stones.Method From January 2008 to October 2009, 365 patients in the Second Hospital of Nanchang, with ureteral stones were admitted to our department for renal colic. They underwent emergency ESWL or elective ESWL with HK. ESWL- 108 energy electromagnetic shock wave lithotripter. Success rate of fragmentation, stone-free rate after 2 weeks of operation, pain recurrence rate, and complications were evaluated. The data were analyzed using SPSS 15.0. Results The success rate of fragmentation and the stone-free rate after 2 weeks of emergency ESWL were 96.76% and96.21%, respectively, which were higher than those (88.33% and 87.22%, respectively) of elective ESWL ( P ＜ 0. 05). The postoperative pain recurrence rate of emergency ESWL ( 4.32 % ) was lower than that (9.44%) of elective ESWL ( P ＜0.05). There was no difference of total complications between emergency ESWL (3.24%) and elective ESWL (2.78%) group (P ＞0.05). Conclusions Emergency ESWL is superior to selective ESWL and is the safe and effective method for the management of ureteral stones.
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Objetivos: La endourología con procedimientos menos invasivos ha sustituido la cirugía convencional en el manejo de algunas patologías, con una baja morbilidad y altos índices de resolución. El progreso de la ureteroscopia con disminución del calibre del instrumental y mejoría de los sistemas ópticos y accesorios han permitido mejor acceso y visión del tracto urinario, disminuyendo los índices de complicaciones. Material y Método: análisis retrospectivo de nuestra experiencia en el abordaje ureteroscópico de lalitiasis ureteral durante el período febrero 2004 - diciembre 2005. Se definió el éxito de la cirugía según la fragmentación completa de la litiasis y la desobstrucción respectiva. Resultados: Se realizaron 50 cirugías, distribuidas en rango etareo 18-83 años, 28 pacientes de sexo masculino y 22 de sexo femenino. El tamaño litiásico abordado varió de 0,5 -2 cm. Se logró la fragmentación completa del cálculo en 92 por ciento de los casos, en 2 pacientes se logró fragmentación parcial y en otros 2 no se logró el acceso por migración de la litiasis. Se describen como complicaciones las inherentes al procedimiento, hematuria, perforación ureteral localizada y 1 caso de falsa vía. Conclusiones: La ureterolitotomia endoscópica resulta un procedimiento seguro y eficaz en la resolución de la litiasis ureteral distal con baja morbilidad asociada, la disponibilidad de la litotripsia intracorporea permite mayor flexibilidad en la indicación de esta técnica. Constituye nuestra modalidad de elección, considerando la poca disponibilidad de litotripsia extracorpórea.
Introduction: Endourology has replaced conventional surgery in management of several urological diseases, with a low morbidity and excellent results. The progress of ureteroscopy with reduced and improved instruments and more advanced optical systems have allowed better access and vision of the urinary tract, reducing the rates of complications. Material and Methods: Retrospective analysis of our experience in the ureteroscopic management of ureteral stones during the period from February 2004 - December 2005. Succesful surgery was define We define as successful according to both the fragmentation of the stones and resolution of obstruction. Results: Fifty surgeries were performed in patients with an age range 18-83 years. Male to female ratio was 3/2. Stone tone size ranged from 0.5 to 2 cm. Complete fragmentation was achieved in 92 percent of the cases, 2 patients achieved partial fragmentation and in one case we experienced migration of stone and the procedure was not completed. The complications rate observed I the series was low. Conclusions: Endourological management of ureteral stones is safe and effective for the resolution of distal ureteral calculi with low morbidity. Availability of intracorporeal lithotripsy allows greater flexibility in the indication of this technique. In our hands this woud be the technique of choice.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Cálculos Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos , Ureteroscopía , Estudios Retrospectivos , Laparoscopía , Resultado del TratamientoRESUMEN
PURPOSE: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.
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Humanos , Bencilatos , Urgencias Médicas , Litotricia , Nifedipino , Nortropanos , Choque , Sulfonamidas , UréterRESUMEN
Objective To evluate the efficacy of ureteroscope and holmium laser in the treatment of ureteral stones. Methods 48 cases of ureteral stones were ureteroscopicaly treated by the use of the above mentioned lithotripter from February 2001 to August 2001. Results 98%(47/48)of the stones being expelled within 5 days after the double J tube were pulled out.No complicaticons occurred. Conclusions Treatment of the ureteral stones by the use of ureteroscope and holmium laser is safe and effective.