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Objective:To investigate the clinical efficacy and safety of transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephroscopy in the treatment of complex renal calculi.Methods:A total of 72 patients with complex renal calculi admitted to Beijing Friendship Hospital, Capital Medical University from November 2019 to April 2022 were prospective selected, which were randomly divided into study group and control group by the random number table method, with 36 cases in each group. The control group underwent single channel minimally invasive percutaneous nephrolithotomy, while the study group underwent transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephrolithotomy. The perioperative indexes (operation time, postoperative hospital stay, intraoperative blood loss), stone removal effect, renal function indicators [blood urea nitrogen (BUN), serum creatinine (SCr)] and complication rate were compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. The Chi-square test or Fisher exact probability method were used to compare the count data of two groups. Results:The operation time [(101.05±11.34) min vs (107.84±10.28) min] and postoperative hospital stay [(8.54±3.15) d vs (12.36±4.08) d] in the study group were significantly shorter than those in the control group, and the difference were statistically significant ( P<0.05). The amount of intraoperative bleeding was close to that in the control group, but the difference was not statistically significant ( P>0.05). The primary stone clearance rate and summary stone clearance rate in the study group were 91.67% (33/36) and 100.0% (36/36), respectively, which were significantly higher than 69.44% (25/36) and 83.33% (30/36) in the control group, and the differences were statistically significant ( P<0.05). The postoperative BUN and SCr levels in the study group were (5.24±0.31) mmol/L and (90.65±25.57) μmol/L, respectively, the control group was (7.69±0.78) mmol/L and (131.96±37.80) μmol/L, respectively. BUN and SCr levels in the study group were significantly lower than those in the control group, and the differences were statistically significant ( P<0.05). The total incidence of postoperative complications in the study group was significantly lower than that in the control group (5.56% vs 16.67%), and the difference was statistically significant ( P<0.05). Conclusion:Transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephroscopy is an ideal method for the treatment of complex renal calculi, which has good removal effect, less complications and helps to improve renal function.
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Objective:To compare the safety and efficacy of 7.5 Fr and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm.Methods:Using a prospective randomized controlled study method, 96 patients with upper urinary tract calculi with maximum diameter<1.5 cm admitted to the Department of Urology, Beijing Friendship Hospital, Capital Medical University from August 2020 to May 2022 were selected as the study subjects. The patients were divided into two groups by random number table method: the experimental group and the control group, with 48 patients in each group. The experimental group patients underwent 7.5 Fr flexible ureteroscopic lithotripsy, while the control group patients underwent 9.5 Fr flexible ureteroscopic lithotripsy. Collect preoperative, intraoperative, and postoperative data from these patients, including success rate of ureteral access sheath insertion, surgical time, lithotripsy time, stone-free rate, ureteral injury status, and complications status. The measurement data were expressed as mean±standard deviation ( ± s), Student- t test was used for comparison between groups; the Chi-square test was used for inter-group comparison of count data, and the Mann-Whitney U test was used for inter-group comparison of rank data. Results:The success rate of primary sheath insertion in the experimental group was 93.8% (45/48), and that in the control group was 79.2% (38/48), the difference between the two groups was statistically significant ( P<0.05). There were no statistically significant difference between the experimental group and the control group in terms of surgical time [(52.0±11.0) min vs (55.1±11.4) min, P>0.05] and lithotripsy time [(26.0±9.3) min vs (23.7±8.7) min, P>0.05]. At four weeks after surgery, the stone-free rate in the experimental group was 93.3% (42/45), while that in the control group was 97.4% (37/38), there was no statistically significant difference between the two groups ( P>0.05). In terms of the degree of ureteral injury, there were 17 patients had grade 0 injury, 27 patients had grade 1 injury, 4 patients had grade 2 injury, and no patient had grade 3 injury in the experimental group; there were 9 patients had grade 0 injury, 23 patients had grade 1 injury, 13 patients had grade 2 injury, and 3 patients had grade 3 injury in the control group; the difference between the two groups was statistically significant ( P<0.05). In terms of complications, there were 22 cases of hematuria, 9 cases of pain, 8 cases of bladder spasm, and 2 cases of mild fever in the experimental group; there were 24 cases of hematuria, 12 cases of pain, 9 cases of bladder spasm, and 1 case of mild fever in the control group; there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The application of 7.5 Fr flexible ureteroscopy and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm can achieve good stone-free rates, but the 7.5 Fr flexible ureteroscopy has a higher success rate of sheath insertion and less damage to the ureter.
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ABSTRACT Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.
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Objective:To compare the performance and surgical outcomes of domestic single-use digital flexible ureteroscopes with reusable digital flexible ureteroscopes in treatment of upper urinary stones.Methods:A prospective, single-blind, multicenter and randomized controlled study was performed from September 2018 to June 2019. Eligible patients were randomly assigned, in a ratio of 1∶1, to either experimental group or control group. The inclusion criteria for the study were: aged 18-75 years, solitary upper urinary stone with stone size between 0.8 and 2.0 cm and CT value less than 1 400 HU, negative preoperative urine culture and normal renal function. Exclusion criteria included: patients with acute urinary tract infection, intransitable urethral strictures, impassable ureteropelvic junction obstructions, systemic hemorrhagic disease, coagulation function abnormalities or bleeding tendency, severe hypertension or cardiopulmonary insufficiency, severe hip malformation and difficulty in meeting the demand of operation position and pregnant and lactation women. The device used in the experimental group was a domestic single-use digital flexible ureteroscope, and the device used in the control group was an imported Olympus digital flexible ureteroscope. The qualified rate of clinical comprehensive evaluation (including image quality and operational performance), the rate of device failure, the stone-free rate and the occurrence rate of adverse events (including increase in urine red blood cell and white blood cell counts, postoperative hematuria, nausea, vomiting, dizziness, and fever) in the two groups were recorded.Results:A total of 186 eligible study cases were collected from the People's Hospital of Wuhan University, the First Affiliated Hospital of Xiamen University, and the First Affiliated Hospital of Guangzhou Medical University. 90 cases in the final experimental group and 88 cases in the control group completed the trial and were included in the evaluation. There were no statistically significant differences among age [(48.40±11.36) vs. (47.40±12.53)years old, P=0.594], male to female ratio (62/28 vs. 56/32, P =0.874), BMI [(24.8±2.1) kg/m 2 vs. (25.1±2.0)kg/m 2,P =0.331], hydronephrosis (no/slight vs. mild/severe) (62/28 vs. 65/23, P =0.874), stone location and stone size [(12.8±4.7) mm vs. (11.9±5.2) mm, P =0.227]. There were no significant differences in terms of qualified rate of clinical comprehensive evaluation [98.9% (89/90) vs. 100.0% (88/88), P =0.991], lithotripsy success rate [84.4% (76/90) vs. 84.1% (74/88), P =0.888], device failure/defect rate (both 0%), and the incidence of adverse events [50.0% (45/90) vs. 52.0% (51/88), P =0.894]. The highest incidence of adverse events in two groups was the increase of red blood cells and white blood cells of routine urine after operation. There was no serious adverse event in the experimental group and 1 serious adverse event in the control group. Conclusions:There was no significant difference in image quality, device failure/defect rate, lithotripsy success rate, and adverse event rate between single-use digital flexible ureteroscopes and reusable digital flexible ureteroscopes for lithotripsy of upper ureteral and pelvic stones. Domestic single-use digital flexible ureteroscopes have good safety and effectiveness in the treatment and microscopy of upper urinary tract stones.
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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 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 evaluate the value of systematic simulation training program in the training of flexible ureteroscopy. Methods The training course was divided into three parts: shifting and positioning of flexible ureteroscope, stone-grasping with basket and lithotripsy by holmium laser. Thirty trainees in the flexible ureteroscopy training class in our hospital in March 2017 were prospectively selected and divided into 2 groups: standardized systematic training group and autonomous training group, with 15 trainees in each group. The trainees in the standardized systematic training group gradually completed the training contents of the three parts in strict accordance with the contents and forms of the training courses using in vitro training dry simulator, spending 60 min in each course, while the trainees in the autonomous training group completed the training by self-study using in vitro training dry simulator for 180 min. After completing the training, the trainees in the two groups were assessed by the in vitro training dry simulator and pig animal surgery, and the examination items included the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser. The operating time and global rating scale (GRS) score for the operation by tutor were compared between the two groups. Results The operating time for the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser in the standardized systematic training group were significantly shorter than those in the autonomous training group (all P<0.05). The GRS scores for the above operations in the standardized systematic training group were higher than those in the autonomous training group (all P<0.05). Conclusion The systematic simulation training program divides the flexible ureteroscopy training course into three separate parts, improves the learning efficiency and enthusiasm of the trainees, helps the trainees quickly mastering the operation skills of flexible ureteroscopy, and shortens the learning curve.
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Objective To investigate the clinical efficacy and safety of flexible ureteroscope combined with holmium laser in the treatment of upper urinary tract calculi(≥2.0cm).Methods One hundred patients with upper urinary tract calculi (≥2.0cm) were divided into control group and observation group according to random digits table method with 50 cases each.The control group was treated with percutaneous nephrolithotomy combined with holmium laser,and the observation group was treated with flexible ureteroscope combined with holmium laser.The operation related index, stone clearance rate and postoperative complications were compared between 2 groups.Results The operation time, two stage stone removal rate and length of hospital stay in observation group were significantly lower than those in control group:(45.76 ± 9.24)min vs.(52.12 ± 10.68)min,2.00%(1/50) vs.16.00%(8/50)and(4.46 ± 1.22)d vs.(5.73 ± 1.91)d,and there were statistical differences(P<0.01 or <0.05).The stone clearance rate in observation group was significantly higher than that in control group:94.59%(70/74)vs.81.69%(58/71),and there was statistical difference(P<0.05).There was no statistical difference in incidence of postoperative complications between 2 groups (P>0.05).Conclusions Flexible ureteroscope combined with holmium laser in the treatment of upper urinary tract calculi (≥2.0cm) can effectively reduce the reoperation rate, shorten the operation time and hospitalization time,and improve the stone clearance rate.The treatment is safe and effective.
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Objeetive To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone.Methods From January 2014 to January 2017,86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital.By adopted to random digital table,86 patients were randomly separated into two groups,all of whom were treated with ureteroscopic holmium laser lithotripsy.Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone.Normal saline was injected continuously through the catheter during lithotripsy procedure (modified lithotripsy group).Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy (direct lithotripsy group).The outcome data were compared between the two groups,such as the operation time,stone clearance rate,ureteral perforation,transit to open surgery,postoperative urinary sepsis,perirenal hematoma,ureterostenosis and other complications.Measurement data were expressed as ((x) ± s),and t test was used for comparison between groups.Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation,rupture,loss of lithotripsy channel,transit to open surgery,perirenal hematoma,and urinary sepsis and so on.In the direct lithotripsy group,there were 5 cases of ureteral perforation,4 cases of lithotripsy channel loss,6 cases of transit to open surgery,2 cases of perirenal hematoma,1 case of urinary sepsis.The operation time of the two groups was (39.5 ± 7.2) min and (47.2 ± 11.6) min,respectively,t =-4.975,P =0.001.Stone clearance rate was 100％,91.1％.The patients in both groups received an average of 1 year out-patient follow-up.There were 3 cases of mild ureterostenosis in the modified lithotripsy group,which were not re-operated.In the direct lithotripsy group,there were 5 cases of mild ureterostenosis,and 2 cases of severe ureterostenosis,which were re-operated.Conclusion It is safe and effective to use the new modified paracalculous uteteral catheter in the ureteroscopic holmium laser lithotripsy of large middle and lower ureteral stone,which can shorten the total operation time and reduce the occurrence of complications.It has a higher clinical value.
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Objective@#To investigate the clinical safety and efficacy of ultrapercutaneous nephrolithotomy combined with ureteroscopy in the treatment of severe urete.@*Methods@#Thirty-six patients (20 males, 16 female) with ureteral obstruction underwent super-mini percutaneous nephroscope combined with flexible ureteroscope balloon dilation of 36 patients, 18 ureteral strictures occurred secondary to ureteroscope lithotripsy, 12 secondary to laparooscopic ureterolithotomy, 6 secondary to ureteral end to end anastomosis and one secondary to bladder ureter reimplantation.@*Results@#All of the surgeries were successful. Mean operation time was 60 min, the hospital stay was 2 to 7 days, and mean bleeding volume was 43 ml. No patients suffered fever, abdominal distention and lumbar distention. All cases were followed up for 12 months. Twenty cases were cured, 10 cases performed better, and 6 cases developed re-stenosis. Treatment efficacy was around 83.3%(30/36).@*Conclusions@#Super-mini percutaneous nephroscope combined with flexible ureteroscope balloon dilation has the advantages of less bleeding, less trauma, shorter hospital stay, and remarkable curative effect, which is worthy of clinical popularization and application.
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Objective To evaluate the feasibility and safety of simultaneous flexible ureteroscopic in the treatment of bilateral upper urinary tract stones from systemic stress response and immune function changes. Methods Sixty bilateral upper urinary tract stones patients who had underwent flexible ureteroscopic lithotripsy (FURL) from December 2015 to December 2017 were selected. The patients were divided into simultaneous FURL treated bilateral upper urinary tract stones (group A, 29 cases) and FURL treated unilateral upper urinary tract stones (group B, 31 cases) according to the treatment method. The perioperative period indexes were recorded. The serum epinephrine (E), norepinephrine (NE), cortisol and peripheral blood T lymphocyte subsets 1 d before operation and 1, 3, 5 d after operation were detected. Results There were no statistical differences in length of stay in hospital, incidence of postoperative complications and stone clearance rate between 2 group (P＞0.05). The operating time in group A was significantly longer than that in group B: (108.3 ± 11.5) min vs. (86.9 ± 13.3) min, and there was statistical difference (P＜0.05). There was no statistical differences in serum E, NE, cortisol and peripheral blood CD3+, CD4+, CD8+, CD4+/CD8+ during perioperative period between 2 groups (P＞0.05). The E, NE and cortisol levels only 1 d after operation in 2 groups were significantly higher than those before operation, and there were statistical differences (P＜0.05); there were no statistical difference between 3 d after operation and before operation (P＞0.05). Compared with those before operation, the peripheral blood CD3+, CD4+and CD4+/CD8+levels 1 and 3 d after operation in 2 groups were significantly lower, the CD8+ was significantly higher, and there were statistical differences (P＜0.05); compared with those 1 d after operation, the peripheral blood CD3+, CD4+and CD4+/CD8+levels 3 d after operation in 2 groups were significantly higher, the CD8+was significantly lower, and there were statistical differences (P＜0.05); There were no statistical differences in peripheral blood CD3+, CD4+, CD8+and CD4+/CD8+ levels in 2 groups between 5 d after operation and before operation (P＞0.05). Conclusions It is feasible, safe and effective to perform simultaneously flexible ureteroscopic for bilateral upper urinary tract calculi patients. And this treatment will not increase the risks of transient adrenal dysfunction and immunosuppression.
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Objective To evaluate and compare the effectivity and safety of mini-percutaneous nephrolithotomy (mPNL) and flexible ureteroscopic lithotripsy (FURL) for diameter 10 to 20 mm renal stone in obese patients. Methods This was a multicenter prospective study. One hundred and ten obese patients (body mass index≥28.0 kg/m2) with diameter 10 to 20 mm kidney stone from January 2015 to May 2017 were selected. The patients were divided into mPNL group (58 cases) and FURL group (52 cases) according to the patients′ will. The operation time, hospitalization time, complication, one-stage stone removal rate and ultimate stone removal rate were compared between 2 groups. Results The operation time, hospitalization time and incidence of complication in FURL group were significantly lower than those in mPNL group: (66.7 ± 21.9) min vs. (85.7 ± 33.4) min, (72.5 ± 23.7) h vs. (120.8 ± 33.5) h and 9.6% (5/52) vs. 31.0% (18/58), and there were statistical differences (P＜0.05). There were no statistical differences in the one-stage stone removal rate and ultimate stone removal rate between 2 groups (P＞0.05). In aspect of postoperative bleeding, hemoglobin decreased after operation (15.8 ± 9.7) g/L in mPNL group; no hemorrhage occurred in FURL group, and no significant changes in hemoglobin were observed before and after operation. Conclusions Both mPNL and FURL achieve satisfactory stone-free rates in obese patients with diameter 10 to 20 mm renal stone. Compared with mPNL, FURL has shorter operation time and lower incidence of complication.
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Objective To evaluate the clinical applications of rigid dilatation using double catheter method for ureteric stenosis.Methods The clinical data of 51 ureteric stenosis patients who had underwent rigid dilatation using double catheters method were retrospectively analyzed. Results Among the 51 patients,the ureteroscopy successfully went through the stricture in 46 cases(90.2%),and all patients had no ureteral perforation or laceration.Among the 5 patients in whom ureteroscopy did not go successfully through the stricture,2 cases were placed double J tube,2 cases underwent percutaneous nephrolithotomy,and 1 case underwent two stage ureteral stricture resection and religation.All patients were examined by ultrasound examination 3 months after the treatment,and the degree of hydronephrosis was partial remission. Conclusions The double catheters method is a safe and effective way for rigid dilatation for ureteric stenosis,and it is worth popularizing.
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Objective To investigate the application effect of stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi. Methods The clinical data of 96 patients with upper ureteral calculi were retrospectively analyzed, all patients underwent ureteroscopic holmium laser lithotripsy. Forty-eight cases used the stone basket in the operation process (observation group), and 48 cases did not use the stone basket in the operation process (control group). The operation time, length of stay, success rate of lithotripsy, stone residual rate and incidence of postoperative complication were compared between 2 groups. Results The patients of 2 groups successfully completed surgery. There were no statistical differences in operation time, length of stay and incidence of postoperative complication between 2 groups (P>0.05). The success rate of lithotripsy in observation group was significantly higher than that in control group: 97.92% (47/48) vs. 75.00% (36/48), and the stone residual rate was significantly lower than that in control group:4.17%(2/48) vs. 18.75%(9/48), and there were statistical differences (P<0.05). Conclusions The stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi can thoroughly remove stones. It reduces the incidence of residual stones, does not affect the safety of the operation, and has good clinical value.
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Objective: To investigate the position and the size of ureteral stone in patients before treated with ureteroscopic lithotripsy or percutaneous nephrolithotomy (PCNL), as well as the dilatation of ureter caused by stone, which may be helpful for better understanding of pathogenesis of ureteral stone and improvement of the diagnosis and treatment in clinic.Methods: A total of 129 cases with ureteral stone for endourologic lithotripsy in Peking University People''s Hospital from Aug.2016 to Mar.2017 were included for the retrospective review.The CT data of the ureteral stones and the ureteral dilatation were collected, including the position of stone, the transverse and longitudinal diameter of stone, and the transverse diameter of dilated upper ureter and ureteropelvic junction (UPJ).The distribution of ureteral stones and dilatation in different parts of ureter were compared and analyzed.Results: All of the 129 cases of ureteral stone, stones were located at UPJ in 9 cases (7.0%), proximal ureter in 75 (58.0%), ureter crossing external iliac vessel (UEIV) in 6 (4.7%), distal ureter in 26 (20.2%), and ure-terovesical junction (UVJ) in 13 (10.1%).The mean transverse diameter of proximal ureteral stones was greater than that of distal ureteral stones [(8.47±2.36) mm vs.(6.74±1.99) mm, P<0.001], as the same as the mean longitudinal diameter [(11.00±4.41) mm vs.(7.50±4.28) mm, P<0.001].In 114 cases of dilated ureter for stone, the UPJ had a greater transverse diameter compared with the upper ureter [(14.39±6.09) mm vs.(11.45±3.85) mm, P<0.001].Conclusion: The most common location of stone is the proximal ureter in patients for endourologic lithotripsy, as the location in UEIV is rare.Both transverse and longitudinal diameters of stone in proximal ureter are greater than those in distal ureter.For dilated ureter, it is more severe in UPJ than in upper ureter.Traditionally, it is accepted that the stones lodge at 3 sites of natural narrowing in ureter, which may be questioned.
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Upper urinary tract calculi with infection is a quite difficult acute urologic emergency.And what is more, upper urinary tract obstruction after radical cystectomy following urinary diversion may be fatal in the vulnerable patients with this kind of situation.Postoperative anatomy and other factors affect the upper urinary tract calculi, and urinary tract infection greatly increased the risk.But it is particularly difficult to handle with patients with poor general condition and septic shock treatment, so how to optimize the selection program is worth further studying.A 65-year-old man was admitted to hospital for combining with renal and ureteral calculi after radical cystectomy (Bricker) in March 2017.The patient underwent transurethral resection of bladder tumor in the outer court because of the discovery of bladder tumor one year before, The postoperative pathology was high-grade papillary urothelial carcinoma and he underwent regular irrigation of the bladder.Because of tumor recurrence, he came to Peking University Third Hospital for further treatment in August 2016, and the examination of urinary tract CT indicated bladder can-cer;for bilateral multiple renal pelvis and renal calices calculi, he was given laparoscopic radical cystecto-my.After four months, due to sudden chill fever, he was hospitalized.After definite diagnosis, anti-inflammatory treatment combined with left nephrostomy was given.The two-stage lithotripsy was performed.After expansion of the original left renal fistula to 24 F(1 F=0.33 mm), 24 F sheath was inducted into the kidney.We introduced a flexible ureteroscopy into the channel down to the ureteral obstruction, where we found a 1 cm oval black brown stone obstructed.A guide wire was inducted through the stones down to ileal conduit in the right lower quadrant.Through the ureteroscopy, we made ureteral calculi broken into powder, and replaced the residual stones into the renal pelvis.Then we used the nephroscopy for lithotropsy in the pelvis, and finally we introduced a flexible cystoscopy for the residual stone.The operation was successful, the operation time was 181 min, and intraoperative bleeding was 10 mL.After operation, no residual stones were found in kidney, ureter, bladder (KUB) plain films.No operation complications were related to the urinary tract.Therefore, multiple endoscopy with combination therapy of upper urinary tract calculi following urinary diversion is safe and effective, and the reasonable choice with the advantages of each instrument can improve the stone clearance rate and shorten the operation time.This can be used as a useful complement to traditional treatment.
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Objective To investigate the the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy(PCNL).Methods The clinical data of 1 patient with massive hemorrhage after PCNL who treated with superselective renal artery embolization and ureteral soft lens were analyzed.Results The patient with postoperative bleeding after PCNL was treated with superselective renal artery branch embolization,after 30d embolization,the holmium laser lithotripsy under the soft ureteroscope for ureteral calculi was performed,and the renal pelvis mucosa smooth,no bleeding and scar formation were intraoperative visible.After operation,the stone was removed basically,and the double J tube was removed 2 weeks after operation.The patient had no special discomfort and the renal function was normal.Conclusion Postoperative 14-30d is a relatively safe time to perform flexible ureteroscopic lithotripsy for super selective renal artery embolization in the treatment of patient with massive hemorrhage after PCNL.
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Objective To improve the experience of diagnosis and evaluate the clinical efficacy and safety of the surgical management for ureteral fibroepithelial polyp.Methods The clinical date of 29 patients with ureteral polyps admitted in Peking Union Medical College Hospital during 2001 to 2014 were analysed retrospectively.The patients' age was between 1 1 to 84 years and 19 were male.Twenty patients with frank pain and two patients with hematuria were enrolled.Seven patients were found hydronephrosis.Results Twenty-nine cases were treated surgically.Fifteen cases were treated by ureteroscopic laser ablation,10 cases local resection and reanastomosis,1 case of abnormalities duplex kidney and ureter underwent local resection and ureteroplasty,2 case Partial ureterectomy including the polyps and pyeloplasty,1 cases nephroureterectomy because of giant hydronephrosis and nonfunctional kidney.No recurrences were seen during a mean follow-up of 32 months (range 10-56 mos).No ureteral stricture occurs.Conclusions Ureteral fibroepithelial polyps represent a rare pathology.Local resection is the main treatment.Endoscopic management is recommended to minimize morbidity and complications in treatment of ureteral fibroepithelial polyps.Recurrences seem to be rare in these tumors.