Intracavitary holmium laser for ureteral calculi combined with distal ureteral stricture / 中国医师进修杂志

ABSTRACT

Objective To evaluate the clinical efficacy of intracavitary holmium laser for ureter calculi combined with distal ureteral stricture.Methods Sixty-nine patients with ureteral calculi combined with distal ureteral stricture were selected.Nineteen patients with ureteral calculi above third lumbar vertebra inferior margin combined with distal ureteral stricture were given microchannel percutaneous nephroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision,and 50 patients with ureteral calculi below third lumbar vertebra inferior margin combined with distal ureteral stricture were given ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision.The type-B ultrasonic,kidney-ureter-bladder plain film (KUB) + intravenous urography (IVU) were performed before operative and 3 months after removal of double J tube,and the degree of hydronephrosis and calculi removal condition were observed.Results The operations of all the patients were successful,and operation time was 42-85 (58 ± 13) min.Intraoperative hemorrhoea,ureteral rupture,ureteral avulsion,false passage formation did not occur.All patients had varying degrees of gross hematuria after operation,and 68 cases disappeared after 2-3 d.Thirteen cases had postoperative fever,and these patients were alleviated after the anti-infection and symptomatic treatment.The success rate of gravel was 95.7％ (66/69),and the success rate of ureteral stricture was 97.1％ (67/69).Three months after removal of double J tube,calculi had been discharged,with no residual calculi.The patients' hydronephrosis was obviously alleviated.The extension of renal collecting system was (22.0 ± 8.2) mm before operation,and was (12.0 ± 6.1) mm 3 months after extraction double J tube,and there was statistical difference (t =8.52,P ＜ 0.01).Conclusions The nicrochannel percutaneous nephroscope holmium laser lithotripsy or ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision for ureteral calculi combined with distal ureteral stricture patients has no serious intraoperative and postoperative complications,shorter operation time,low cost,operation safety,and satisfactory effect.It is a good method for ureteral calculi combined with distal ureteral stricture.