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【Objective】 To analyze the independent influencing factors of repeated extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary calculi (UUC), based on which a nomogram model was established to predict the efficacy. 【Methods】 Clinical and imaging data of 203 patients receiving repeated ESWL during Jan.2020 and Dec.2022 were collected, including 117 cases in the successful group and 86 cases in the unsuccessful group.The patients’ age and sex, stone volume (SV), surface area (SA), skin-to-site distance (SSD), maximum CT value, mean stone density (MSD), and stone heterogeneity index (SHI) were compared between the two groups.The independent predictors were analyzed with logistic regression and the meaningful variables (P<0.05) were used to establish a nomogram.The efficacy of the model was evaluated using receiver operating characteristic (ROC) curve and decreasing curve analysis (DCA).Internal validation was also performed. 【Results】 Stepwise regression showed that SV, SSD, MSD and SHI were independent influencing factors (P<0.05).The area under the ROC curve (AUC), optimal threshold, sensitivity and specificity were 0.793 (95%CI: 0.674-0.911), 0.619, 77.1% and 74.0%, respectively.The DCA curve was above two extreme curves.Hosmer-Lemeshow test and calibration curve showed that the nomogram had a good fitting degree (χ2=5.526, P=0.489), and the correction C-index was 0.746. 【Conclusion】 SV, SSD, MSD and SHI are independent predictors of the efficacy of repeated ESWL in the treatment of UUC.The nomogram established based on the above indicators has good predictive efficiency and clinical applicability.
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Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9％,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6％ (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P ＜ 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P ＜ 0.05) and position (x2 =44.949,P ＜ 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system (Microperc) for the treatment of upper urinary calculi in children.Methods Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People's Hospital was performed,including 18 boys and 7 girls.The age of patients was (6.4 ± 3.9) years (10 months-14 years),and 4 cases were less than 3 years old.Among them,3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 rmm).Stone fragmentation was performed by using a 200 μm holmium (YAG laser fiber).Results All patients were successfully treated in stage I.In 6 patients,access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8 ± 15.1) min (40-100 rain).The mean postoperative drop in hemoglobin was (7.5 ± 5.4) g/L,and no patient required blood transfusion.The hospital stay was (4.9 ± 1.2) days (3-6 days).There were residual fragments in 3 patients,and the overall stone-free rate at 4 weeks was 88％ (22/25 cases).Four cases had a fever(Clavien grade Ⅰ) complications,while no grade Ⅱ and grade Ⅲ complications were observed.Conclusions Microperc can establish a surgical channel through visual images quickly and safely,and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery,but also for patients with mild hydronephrosis and children with calculus.
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Objective@#To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system(Microperc)for the treatment of upper urinary calculi in children.@*Methods@#Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People′s Hospital was performed, including 18 boys and 7 girls.The age of patients was (6.4±3.9) years(10 months-14 years), and 4 cases were less than 3 years old.Among them, 3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 mm). Stone fragmentation was performed by using a 200 μm holmium(YAG laser fiber).@*Results@#All patients were successfully treated in stage I. In 6 patients, access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8±15.1) min (40-100 min). The mean postoperative drop in hemoglobin was (7.5±5.4) g/L, and no patient required blood transfusion.The hospital stay was (4.9±1.2) days (3-6 days). There were residual fragments in 3 patients, and the overall stone-free rate at 4 weeks was 88%(22/25 cases). Four cases had a fever(Clavien grade Ⅰ) complications, while no grade Ⅱ and grade Ⅲ complications were observed.@*Conclusions@#Microperc can establish a surgical channel through visual images quickly and safely, and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery, but also for patients with mild hydronephrosis and children with calculus.
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Objective To discuss the application value of computer graphic imaging techniques combined with CT urography in surgical scheme selection for upper urinary calculi.Methods 97 cases with complex upper urinary calculi underwent CT urography examination.The images were transferred by network to a separate workstation to perform volume rendering (VR),maximum intensity projection (MIP),multiplanar reconstruction (MPR) and curved planar reconstruction (CPR).All the post processing images were analyzed for selecting the appropriate surgical scheme.Results The 97 cases were treated properly according to their CT urography examination images,and all patients recovered without complications.Conclusion Urinary calculi and slight changes in the anatomical structure of upper urinary tract can be clearly demonstrated by computer graphics imaging techniques combined with CT urography,which may provide more information for disease diagnosis and selection of surgical scheme.
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Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.
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Objective To evaluate the clinical efficacy of flexible ureteroscopy combined with physical vibration lithecbole in treatment of massive upper urinary calculi. Methods The clinical data of 62 cases with massive upper urinary calculi from Feb 2016 to Mar 2017 were analyzed retrospectively. The average diameter of stones were (656.70 ± 275.40) mm2. The removal rate of stones, general conditions during the operation, the postoperative adverse reactions and renal function changes were observed. Results All 62 patients had successfully completed flexible ureteroscopy operation, and had physical vibration stone removal treatment after 1 week. The rate of stone removal was 61.29％ in the next day (38/62), 85.48％ (53/62) in the next 1 week and 96.77％ (60/62) in the next 3 weeks. Postoperative fever occurred in 2 cases, the overall complication rate was 3.23％. 18 patients had improved renal function while 4 patients keep stable after operation. Conclusion The flexible ureteroscopy combined with physical vibration lithecbole is a safe and effective therapeutic method for massive upper urinary calculi. It has high stone removal rate, less complications, little impact on renal function. It is valuable to advocate clinically.
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Objective To investigate the infection status of nanobacteria on patients with upper urinary calculi and healthy sub-jects ,and analyze the role of nanobacteria in the formation of upper urinary calculi .Methods The serum ,urine and calculus of 42 patients with upper urinary calculi were investigated by polymerase chain reaction (PCR) and by bacteria cultivation with 10% γ-FBS and PMBI 1640 .The resulting PCR products were sequenced for further comparison with the reported sequence in gene bank . The serum and urine from 30 healthy adults were used as controls .Results After 4 to 6 weeks′culture ,the white or yellow precipi-tate was visible at the bottom of the tube .The positive rate of PCR was 90 .4% in calculous patients urine and 6 .7% in healthy a-dults urine ,as the positive was 92 .8% and 6 .7% in serum .which there is significant difference (P<0 .01) .The positive rate of the nanabactria in urinary calculi was 95 .2% .The coincidence rate was 98 .72% between the PCR products and the reported sequence in gene bank .Conclusion Nanobacteria are widely existed in the serum ,urine and calculus of the patients with upper urinary calcu-li ,this indicate that the nanobacteria might be have the most important influence on the formation process of urinary calculi .
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Objective To analyze the clinical indications,efficacy and safety of Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi based on our experience.Methods From June 1992 to September 2010,a total of 10,452 patients (6060 males and 4392 females)with a mean age of (47.6 ± 13.7) years (7 months-93 years) received MPCNL in our center.The mean stone burden was (777.4 ± 740.3) mm2 (20 - 4 080 mm2 ).The data of stone burden,operative techniques,operating time,stone-free rate,major complication,hospital stay and stone composition were investigated. Results Of the 10 452 cases,11 801 procedures were performed on 10 876 (5493 left and 5383right) renal units,including 10 102 first stage procedures,1604 secondary procedures,86 third procedures and 9 fourth procedures.There were 11 830 tracts established,including 373 (3.15％ ) tracts of 14 F,7867 (66.50％) tracts of 16 F and 3590 (30.35％) tracts of 18 F.There were 1207 (10.20％),9174(77.55％) and 1449 (12.25％) punctures located in upper,middle and lower pole,respectively.956(8.79％) renal units were managed with multiple tracts,which including 2 tracts in 846 (7.78％) units,3tracts in 85 (0.78％) units,4 tracts in 18 (0.17％) units and 5 tracts in 7 (0.06％) units.Pneumatic lithotripsy was used in 8563 (72.56％) procedures,Holmium:YAG laser lithotripsy was used in 2981(25.26％) procedures and Pneumatic lithotripsy + Holmium: YAG laser lithotripsy was used in 257(2.18％) procedures.762 (7.29％) cases needed ESWL to clean the stone after MPCNL.The average operating time was ( 101.3 ± 44.2) min ( 10 -240 min).The stone-free rate of MPCNL was 89.9％,which increased to 93％ by adjunctive ESWL.And the mean hospital stay was ( 13.2 ± 6.4) days (2 - 72 days).The major complications happened on 321 (3.07％) cases,including 294 (2.81％ ) cases of blood transfusion,12 (0.11％ ) cases of sepsis,2 (0.02％) cases of renal abscess,9 (0.09％) cases of pleura injury,2 (0.02％) cases of colon injury and 2 (0.02％) cases of death.53 (0.51％) cases needed selective renal arterial embolization to achieve hemostasis.The main stone compositions were analyzed in 4345 cases.Calcium oxalate,calcium phosphate,magnesium ammonium phosphate,uric acid,ammonium urate,carbapatite and cystin were 91.74％,90.33％,14.91％,17.77％,4.83％,8.47％ and 0.51％,respectively. Conclusions MPCNL is an effective and safe treatment option for all kinds of upper urinary calculi in patients at all ages with a high stone free rate and low major complication rate.
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Objective To study and evaluate the therapeutic safety and effect of frequency-doubled-double-pulse laser(FREDDY)lithotripsy for treating upper urinary calculi combined with acute renal failure.Methods The clinical data of 32 cases treated by frequency-doubled-double-pulse laser(FREDDY)lithotripsy were retrospectively analyzed.Results After the operation the serum BUN and Cr levels in the patients got close or returned to normal and the free rate of the stones was up to 90.6%(29/32).Conclusions The ureteroscopic frequency-doubled-double-pulse laser(FREDDY)lithotripsy has the advantage of safety,high efficiency and less trauma for treating the upper urinary tract obstruction combined with acute renal failure.It can also deal with the bilateral ureteral stones at one time.It can be the first choice when the condition is proper.