Clinical application of ureteroscope in the treatment of infant renal calculus with acute post-renul failure / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the clinical application of ureteroseope in the treatment of infant renal calculus with acute post-renal failure. Methods Thirteen cases of infant renal calculus with acute post-renal failure included 11 males and 2 females aging from 5 months to 1 years with a mean age of 9 months. Five cases showed bilateral renal calculi with hydronephrosis, 3 cases showed one side renal calculus with eontralateral uretal calculus incarceration, 3 cases showed bilateral uretal calculus incarceration, 2 cases showed bilateral renal calculi and hydronephrosis with urinary calculi. Anuria appeared in 11 cases for 1-3 d while oliguria appeared in 2 cases for 5-10 d. BUN and SCr were higher than normal level in all cases. Hyperuricemia was found in 8 cases, hyperkaliemia was found in 9 cases, pH values in urine of all infants were less than 6. 5(mean, 5. 5). Radiopague stone was not found in all cases by KUB. Hydronephrosis was found in 13 cases, and the diameter of hydro-nephrosis in 9 cases was more than 2.5 cm by B ultrasound. All cases were diagnosed as urinary stones with the diameter from 0.5 to 1.5 cm by CT. All cases were inserted with double J stents un-der ureteroscope for internal drainage, crushing, rinsing and eliminating stones. Results Hyperdi-uresis emerged within 24 h after operation in 13 patients. The duration of hyperdiuresis was from 24 h to 72 h. Urine volume revived gradually 48-96 h after operation while BUN and SCr revived 1-5 dafter operation. Serum uric acid revived 1-7 d after operation in 8 cases of hyperuricacidemia. Serum potassium revived 1-3 d after operation in 9 cases of hyperpotassaemia. Double J tubes were detained for 2-4 weeks. Renal calculus in 10 cases were found by B ultrasound to be discharged and conse-quently double J tubes were pulled out. Renal calculi in 2 cases became smaller and lighter. Conclu-sions For infant renal calculus with acute post-renal failure, upper urinary obstruction could be re-lieved immediately with revived urination and improved renal function by dissolution and crushing of calculus, and the placement of double J tube for internal drainage under ureteroscope. This operation is safe, high-efficient with less lesion, and would be the first option to relieve obstruction for infant re-nal calculus with acute post-renal failure.