The optimal management of large upper ureteral stones (> 1.5 cm) with infection in elderly patients: a comparative analysis of three minimally invasive surgical approaches.

PURPOSE: The aim of this study was to investigate the efficacy and safety of three minimally invasive surgical approaches for treating large upper ureteral stones complicated by infection in elderly (> 60 years) patients. METHODS: Clinical data from 95 elderly patients with large upper ureteral stones and infection, treated at our hospital between January 2018 and April 2023, were retrospectively analyzed. The surgical approaches included FURL (flexible ureteroscopic lithotripsy) 33 cases, mPCNL (minimally percutaneous nephrolithotomy) 29 cases, and RLUL (retroperitoneal laparoscopic ureterolithotomy) 33 cases. Surgical time, intraoperative blood loss, postoperative hospital stay, reoperation rate, incidence of postoperative complications, and hospitalization costs were observed and compared among the three groups. RESULTS: No statistically significant difference was found in stone clearance rates among the three groups (P > 0.05). The FURL group exhibited advantages over the mPCNL and RLUL groups in surgical time, intraoperative blood loss, and postoperative hospital stay (P < 0.05). However, it also had the highest reoperation rate and hospitalization costs (P < 0.05). RLUL demonstrated superiority over the mPCNL and RLUL groups in terms of reoperation rate, incidence of complications, and hospitalization costs (P < 0.05). Notably, mPCNL exhibited the highest complication rate at 37.9% (P < 0.05). CONCLUSION: For elderly patients with large upper ureteral stones complicated by infection, FURL, mPCNL, and RLUL represent effective surgical approaches. Further attention is needed regarding the perioperative safety of mPCNL. RLUL, which offers higher safety, efficacy, and cost-effectiveness, can be considered a primary surgical option for these patients.

Propensity score matched comparison of transperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for management of large impacted proximal ureteral stones with long-term follow-up.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15 mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4 g/dL vs. 1.5 ± 0.7 g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15 mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Clinical study of UMP and RIRS in 1.0-2.0 cm diameter renal/upper ureteral calculi.

BACKGROUND: The purpose of this study was to compare the efficacy and safety of Ultra-mini-percutaneous nephrolithotomy (UMP) and Retrograde intrarenal surgery (RIRS) for renal/upper ureteral calculi in 1.0-2.0 cm diameter. METHODS: From October 2017 to October 2022, the surgical treatment of patients with renal/upper ureteral calculi in 1.0-2.0 cm diameter who were admitted to our hospital was retrospectively analyzed. They were divided into two groups, the UMP group (sixty-two cases) and the RIRS group (one hundred and nine cases), according to the different surgical methods. Baseline data includes general information, stone size, location, CT value, hydronephrosis, creatinine level, etc. RESULTS: Intraoperative blood loss was 33.6 ± 8.5 ml in the UMP group was significantly more than 4.3 ± 0.7 ml in the RIRS group (P < 0.05). Intraoperative renal pelvis pressure of UMP group 10.5 ± 1.3 mmHg was significantly lower than RIRS group 23.6 ± 5.6 mmHg (P < 0.05). The incidence of postoperative infection was higher in the RIRS group (thirteen cases [11.93%]), and one case ([1.61%]) in the UMP group (P < 0.05). Routine CT scans on the second day and two months after surgery showed that the stone clearance rates in the UMP group were 87.1% and 93.5%, respectively, higher than those in the RIRS group (69.7% and 79.8%, respectively; P < 0.05). CONCLUSION: UMP has the advantage of a higher stone-free rate but a higher risk of injury and bleeding. The advantages of RIRS include less trauma, less bleeding, and faster recovery, but lower stone-free rates and a higher risk of infection.

Analysis and prediction of postoperative recurrence of unilateral upper ureteral calculi in 243 cases (nomogram).

Objective: This study aimed to identify the risk factors for postoperative recurrence of unilateral upper ureteral calculi and develop a predictive nomogram. Patients and Methods: A retrospective analysis was conducted on 243 patients diagnosed with unilateral upper ureteral calculi who were treated at our hospital between January 1, 2016 and December 31, 2018. Patients were divided into two groups: recurrence or non-recurrence cohort. Differences in age, gender, smoking and/or drinking habit, laterality, stone diameter, ureteral stricture, stone incarceration, urinary tract infection, surgical intervention, operation time, body mass index, and metabolic syndrome were analyzed. Discrete risk factors were screened, and a nomogram was developed to predict the probability of stone recurrence. Results: The study found that the recurrence of ureteral calculi was associated with factors including stone diameter, ureteral stricture, stone incarceration, surgical intervention, operation time, metabolic syndrome, body mass index, triglycerides, diabetes, and high blood pressure (p < 0.05). Ureteral stricture, surgical intervention, metabolic syndrome, and triglycerides were found to be discrete risk factors for stone recurrence (p < 0.05). In addition, the study revealed that the stone recurrence rate of metabolic syndrome patients was significantly elevated (p < 0.05), as demonstrated by the survival curve. Lastly, using the nomogram, with an area under the curve value of 0.929, the recurrence rate of ureteral calculi was predicted. Conclusions: The study identified that preoperative ureteral stricture, laparoscopic ureterolithotomy, metabolic syndrome, and triglycerides are closely related to postoperative recurrence of ureteral calculi. The nomogram developed in this study can be used as a predictive tool for the recurrence rate of ureteral calculi.

Efficacy and feasibility of self-made negative pressure reflux system combined with rigid ureteroscope in the treatment of upper ureteral calculi in exercise-minded patients

Objective: To explore the efficacy and feasibility of self-made negative pressure reflux system combined with rigid ureteroscopy in the treatment of upper ureteral calculi.Methods: The clinical data of 379 Exercise-minded patients with upper ureteral calculi treated in our hospital from January 2018 to August 2022 were analyzed retrospectively. F8.0/9.8STORZ ureteroscope was used to explore the ureteral opening on the affected side, and then the 200μm wavelength holmium laser fiber and F4 ureteral catheter were inserted into the stone incarceration site through the rigid ureteroscope, and the residual stone fragments which were clinically meaningless (the maximum diameter of the stone < 2mm) were completely sucked out by negative pressure reflux system.Results: A total of 379 Exercise-minded patients were included in this study, with a one-time success rate of 97.1% (368/379), aged 26 to 76 years, with an average of (47.5) years. Most of the Exercise-minded patients (63.2%) had low back pain and hematuria before operation. The average diameter of stone was 0.8cm~2.8cm, the mean diameter of the stone was 1.8±1.0 cm.The operation time ranged from 18min to 52min, with an average of (37.86±25.64)min.The average length of hospital stay was (2.7±1.7) days (range, 1-8 days). On the first day after operation, the stone clearance rate was 84.43% (320/379), and the stone clearance rate was 90.77% (344/379) 3 months after operation. Among them, 4 Exercise-minded patients developed fever and 6 Exercise-minded patients had mild urinary fistula or renal pelvis perforation. Stone composition analysis was mainly ammonium phosphate stones and calcium oxalate stones.Conclusion: The treatment of upper ureteral calculi with self-made negative pressure reflux system combined with hard ureteroscope has the advantages of high stone clearance rate, low complications and greatly reducing the utilization rate of soft lens，and had high clinical promotion value. (AU)

Comparison of the efficacy and safety of ShuoTong ureteroscopy and flexible ureteroscopy in the treatment of upper ureteral calculi with CT numberical value greater than 1000 HU / 中华泌尿外科杂志

Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.

Efficacy of flexible vacuum aspiration ureteral access sheath for renal and upper ureteral calculi / 现代泌尿外科杂志

【Objective】 To investigate the safety and efficacy of flexible vacuum aspiration ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal and upper ureteral calculi. 【Methods】 Clinical data of 41 cases treated in our hospital were retrospectively analyzed, including 20 cases treated with flexible vacuum aspiration ureteral access sheath (experimental group), and 21 cases treated with traditional ureteral access sheath (control group). The stone-clearance rate, operation time, postoperative fever (T>37.5 ℃), length of hospital stay and hospitalization costs were compared between the two groups. 【Results】 All operations were successful. The experimental group had significantly shorter operation time than the control group [(54.0±19.8) min vs. (76.6±20.1) min, P0.05). 【Conclusion】 Flexible vacuum aspiration ureteral access sheath in flexible ureteroscopic lithotripsy can shorten the operation time, improve stone-clearance rate and reduce incidence of postoperative fever, which is worth promoting.

Application of flexible ureteroscope in the treatment of middle and upper ureteral calculi complicated with lower ureteral stricture / 现代泌尿外科杂志

【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.

Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi.

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi.

OBJECTIVE: To investigate the clinical efficacy of a novel vacuum suction ureteroscopic approach in the treatment of upper ureteral calculi and to compare it with traditional rigid and flexible ureteroscopic approaches. SUBJECTS AND METHODS: A total of 160 patients with impacted upper ureteral calculi were included in this study. 50 patients underwent rigid ureteroscopic lithotripsy, 54 patients underwent flexible ureteroscopic lithotripsy, and 56 patients underwent vacuum suction ureteroscopic lithotripsy. The operative time, length of hospitalization, stone-free rate, the incidence of postoperative complications, and total treatment cost were compared among the three groups. Subgroup analysis was performed based on the stone diameter over and below 1.5 cm. RESULTS: All operations were performed successfully, and there were no cases converted to open surgery. Compared with the other 2 groups, the vacuum suction ureteroscopy group had a higher stone-free rate at 3-5 days (90.0% vs. 61.9% vs. 55.6%, P < 0.05) and 1 month (96.4% vs. 77.7% vs. 74.0%, P < 0.05) postoperatively. In subgroup analysis, the stone-free rate of the vacuum suction ureteroscopy group was significantly higher when the stone diameter was > 1.5 cm at 1 month postoperatively (P < 0.05) compared with that in the other 2 groups; however, there were no differences in postoperative complications. (P > 0.05). CONCLUSION: The novel vacuum suction ureteroscopic lithotripsy has significantly improved the stone-free rate especially in complicated cases, compared with that in rigid and flexible approaches; however, the complication and cost were not increased.

Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years).

PURPOSE: To summarize the experience of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of upper ureteral calculi and long-term follow-up results and compare them with ureteroscopic lithotomy (URL) and percutaneous nephrolithotomy (PCNL). METHODS: The clinical data of 585 patients with complex upper ureteral calculi who met the inclusion criteria from January 2006 to December 2017 were retrospectively analyzed. There were 206 cases treated with RLU, 201 cases treated with URL and 178 cases treated with PCNL. The operation time, hospitalization time, stone clearance rate, incidence of postoperative complications and recurrence rate were observed and compared among the three groups. RESULTS: Among 585 eligible patients, 206 cases were treated with RLU, 201 cases were treated with URL and 178 cases were treated with PCNL. The stone clearance rate (98.54%), postoperative complication types and rate (0.97%) in the RLU group were superior to those in the URL group and the PCNL group (P < 0.05). There was no significant difference in the recurrence rate (3.88%) between the RLU group and the other two groups (P > 0.05). CONCLUSION: Retroperitoneal laparoscopic ureterolithotomy has many advantages in the treatment of upper ureteral calculi, including high stone clearance rate, less complications especially in ureteral stricture. Retroperitoneal laparoscopic ureterolithotomy is also safe to treat upper ureteral calculi accompanied with severe urinary tract infection.

Therapeutic effect of ureteroscopic pneumatic lithotripsy and percutaneous renal holmium laser lithotripsy for upper ureteral calculi / 局解手术学杂志

Objective To investigate the efficacy of ureteroscopic pneumatic lithotripsy and percutaneous renal holmium laser lithotripsy in the treatment of upper ureteral calculi. Methods A total of 132 patients with upper ureteral calculi admitted to our hospital from December 2016 to December 2017 were randomly divided into observation group and control group, 66 cases in each group. The control group underwent ureteroscopic pneumatic lithotripsy, and the observation group used percutaneous nephrolithotomy holmium laser lithotripsy. The clinical efficacy, surgical index and complication rate between two groups were compared. Results The clinical efficacy of the observation group (90. 91％) was higher than that of the control group(75. 76％),and the difference was statistically significant(P ＜ 0. 05). The operation time of the observation group was (27. 53 ± 3. 97) minutes,which was shorter than (42. 59 ± 4. 34) minutes of the control group,and the postoperative blood loss was (18. 59 ± 5. 21) mL,which was less than (31. 68 ± 4. 72) mL of the control group, the difference was statistically significant(P ＜ 0. 05). There was no significant difference in postoperative hospital stay between observation group[(5. 31 ± 1. 62) days]and control group[(5. 28 ± 1. 48) days](P ＞ 0. 05). There was no significant difference in the incidence of complications between two groups (P ＞ 0. 05). Conclusion Percutaneous nephrolithotomy with holmium laser lithotripsy is more effective than pneumatic lithotripsy in the treatment of upper ureteral calculi. It can shorten the operation time, reduce the amount of bleeding, and has higher safety.

Guide sheath-assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81 cases.

The present study assessed the clinical efficacy of guide sheath-assisted ureteroscope lithotripsy in the treatment of upper ureteral calculi. A total of 81 patients with upper ureteral calculi underwent ureteroscope lithotripsy assisted by a guide sheath between January 2012 and June 2014; of these, 63 patients were successfully treated with simple rigid ureteroscope lithotripsy assisted by a ureteral access sheath, and 18 patients were successfully treated with rigid and flexible ureteroscope lithotripsy assisted by a guide sheath. At 1 day after the surgery, ultrasound examination of kidneys, ureters and bladder, and urinary system computed tomography were used to re-check for residual stones, and 69 patients had stones with a diameter of <2 mm in the renal pelvis, while 12 had stones of 2-4 mm in diameter. The operation time was 30-115 min (average, 56.0±4.8 min); all patients underwent a successful surgical procedure. A total of 7 patients had an elevated temperature 37.4-39.1°C (mean temperature, 37.7±0.3°C) after the surgery, but no other major complications were noted. After 1 month, the residual stones were completely discharged, so that the stone clearance rate was 100%. All patients were followed up for 3-12 months and no associated complications occurred. Overall, ureteroscope lithotripsy assisted by a guide sheath for the treatment of upper ureteral calculi had the benefit of water injection and reflux functions, as well as enhanced vision, reduced pressure within the renal pelvis, good discharge of stones as well as an improved efficiency and success rate compared with simple ureteroscopic lithotripsy.

The study of duration of indwelling ureteral stent after the ureteroscopic lithotripsy / 中华泌尿外科杂志

Objective To investigate the duration of indwelling ureteral stent after the ureteroscopic lithotripsy.Methods 300 cases of patients were retrospectively analyzed from June 2015 to June 2017,including 168 with renal calculi and 132 with non-incarcerated upper ureteral calculi.The size of stone is ＜2 cm in diameter.According to the length of time for indwelling ureteral stent,all patients were divided into two groups-150 cases in 14-day group (Group A) and 150 in the 28-day group (Group B) for comparing the complication and outcome,and then received modular flexible ureteroscopic lithotripsy combined with holmium laser.Lastly,6F ureteral stent was indwelling postoperatively.Results Complications happened in both two groups after stenting.There were 140 cases (93.3％) complained of bladder irritation symptoms (LUTS) in Group A,while 107 (71.3％) in Group B;85 cases (56.7％) suffered from flank or abdominal pain in Group A and 36 (24％) in Group B;gross hematuria happened in 133 cases (88.7％) of Group A and 60 cases (40％) of Group B.As the duration of indwelling ureteral stent extended,the incidence of complications increased,significantly (P ＜ 0.05).CT scan showed there was no statistical difference in stone-free rate (diameter ＜ 3 mm) of two groups [A group:91.3 ％ (137/150) vs.B group:89.3 ％ (134/150),respectively].Conclusion With high stone-free rate and low complication incidence,2-week indwelling ureteral stent is safe for patients suffered from renal calculi or non-incarcerated upper ureteral calculi (diameter ＜ 2 cm).

Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of upper ureteral calculi in paediatric patients / 中国内镜杂志

Objective To evaluate the efficacy and safety of tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of upper ureteral calculi in paediatric patients. Methods 20 cases of children with upper ureteral calculi (age≤7 years old), in our hospital underline of modular flexible ureteroscope combined with ultramini nephrostomy tract lithotripsy, the stones located on the left side in 12 cases, 8 cases on the right. The average age of children in the 4 years (2 to 7 years), the average diameter of stones 1.0 cm (0.7 ~1.5 cm), multiple 9 (including 3 cases of multiple bilateral, 6 cases of unilateral multiple) single stones 11 cases. Ultrasound-guided percutaneous nephrolithotomy establish supermicro channel (F11), application modular and flexible uretero﹣scope holmium laser lithotripsy systems. Results Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract calculi Clear Phase 91%(21/23), 2 cases of bilateral stones with phased surgical treatment, surgi﹣cal staging stone clearance rate was 100 % (23/23). Postoperative hemoglobin decline was no significant change. Children do not need a blood transfusion, creatinine, blood urea nitrogen and CRP were no significant differences in change, not placed before and after surgery and renal fistula DJ tube (no tube-based). The mean postoperative hospi﹣tal stay was two days, followed up for 6 months to 1 year, all patients had no long-term complications. Conclusion Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of Upper ureteral calculi in paediatric patients is an effective and safety method, can shorten hospital stay.

Treatment of upper ureteral calculi by an ureteroscopy approach in a low-head lithotomy with right or left lateral tilt / 中国内镜杂志

ObjectiveTo evaluate the methods in treatment of upper urinary calculi in a low-head lithotomy with right or left lateral tilt by an ureteroscopy approach. Methods From September 2009 to May 2015, 110 patients with upper ureteral calculi (after failed ESWL) were underwent holmium laser lithotripsy by a ureteroscopy approach in a low-head lithotomy with right or left lateral tilt. Their clinical data and complications were analyzed retrospectively. Results Surgical effect of patients was satisfied with the success of gravel 91 patients, with a total rate of 82.7 %gravel. Conclusion Low-head lithotomy with right or left lateral tilt is a good body position to perform ureteroscopic lithotripsy for upper ureteral calculi. It is safe and effective.

Clinical research on laparoscopic ureterolithotomy combined with flexible ureteroscopy for treatment of middle and upper ureteral calculi with ipsi-lateral kidney calculi / 中国现代医生

Objective To explore and analyze the efficacy of laparoscopic ureterolithotomy combined with flexible ureteroscopy for treatment of middle and upper ureteral calculi with ipsilateral kidney calculi. Methods All 64 cases who were diagnosed with middle and upper ureteral calculi with ipsilateral kidney stones in our hospital from October 2010 to October 2013 were chosen as the research subjects. All of the clinical data were analyzed retrospectively. Pa-tients were divided into observation group(33 cases) who were treated with laparoscopic ureterolithotomy combined with flexible ureteroscopy and the control group (31 cases) who were treated with traditional open surgery randomly. The short-term clinical effects between two groups were compared after 8 months. Results The surgical bleeding,opera-tion time,hospital stays and the recovery time of observation group were all lower than those of control group(P<0.05). The body mass and Karnofsky scores after surgery of two groups were all higher than those before surgery. Quality of life of the observation group was better than that of the control group(P<0.05). The complications rate of the observation group was lower than that of the control group(P<0.05). Conclusion Laparoscopic ureterolithotomy combined with flexible ureteroscopy for treatment of middle and upper ureteral calculi with ipsilateral kidney stones has such advan-tages as better efficacy,smaller trauma,faster postoperative recovery,higher stone clearance rate,fewer adverse reac-tions and higher quality of life compared with traditional open surgery. It is worthy of promotion.

Contrastive study of percutaneous nephrolithotomy and ureteroscopy for impacted upper ureteral calculi / 中国医学装备

Objective:To compare the clinical effects of Percutaneous nephrolithotomy lithotripsy (PCNL) and transurethral ureteroscopy (URL) in the treatment of impacted upper ureteral calculi.Methods:Since 2008, There were 144 cases with incarcerated upper ureteral calculi in hospital, all patients were divided into two groups according to the different ways of treatment, the PCNL group with 72 cases and the URL group with another 72 cases. Monitor and record the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation, average length of stay and total costs of the two groups. Through the Analysis to the data obtained, compare the clinical results of PCNL and URL in the treatment of impacted upper ureteral calculi.Results: For PCNL group, the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation was 95.8% (69/72), 93.1% (67/72) and 98.6% (71/72), while for URL group, the data was 84.7% (61/72), 83.3% (60/72) and 86.1% (62/72), the difference was statistically significant (x2=5.18,x2=5.85,x2=6.49;P<0.05); The operation time, average length of stay and total costs for PCNL group are greater than the URL group, and the difference was statistically significant(t=3.80, t=4.87,t=5.34;P<0.05).Conclusion: PCNL compared with the URL in the treatment of impacted upper ureteral calculi has a better performance on stone clearance, but there are problems of higher costs and longer hospital stay. Accordingly, patients need a comprehensive comparison and choose the appropriate way.

Application of double-J stents in extracorporeal shock wave lithotripsy for the treatment of middle and upper u-reteral calculi / 局解手术学杂志

Objective To evaluate the efficacy and safety of double-J stents in extracorporeal shock wave lithotripsy for the treatment of middle and upper ureteral calculi, and to explore the reasonable application of double-J stents. Methods 511 patients with middle and up-per ureteral calculi in our hospital were selected as the statistical objects. 161 patients of the catheter group were indwelled double-J stent be-fore extracorporeal lithotripsy while the other 350 patients in the no-catheter group underwent extracorporeal shock wave lithotripsy directly. The satisfaction rate of X-ray display location, gravel effect, and rate of adverse reaction were compared. Results The satisfaction rate of X-ray display location in the catheter group was higher than the no-catheter group (P=0. 025). And the gravel effect of the two groups were of statistical significance (P=0. 041). The incidence of hematuria and lower urinary tract symptoms in the catheter group was significantly high-er than that in the no-catheter group (P<0. 05). The incidence of renal colic in catheter group was lower than that in no-catheter group (P=0. 001). Conclusion Indwelling double-J stents is useful for stones display and localization, and it can improve the stone clearance rate. For ureteral stones whose diameter were less than 1 cm, double-J stents has little influence on the rate of stone clearance, but it can reduce the occurrence of severe renal colic.

Comparison of Minimally Invasive Percutaneous Nephrolithotomy and Retroperitoneal Laparoscopic Ureterolithotomy for Impacted Upper Ureteral Calculi / 中国微创外科杂志

Objective To compare the therapeutic effects of minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneal laparoscopic ureterolithotomy(RLUL) in the management of impacted upper ureteral calculi.Methods A total of 72 patients with unilateral impacted upper ureteral calculi were treated with MPCNL(n=45) or RLUL(n=27).The operation time,clearance rate of the stone,and the incidence of postoperative hyperpyrexia were statistically analyzed.Results All the operations were completed.As compared to the RLUL group,the MPCNL group had a significant shorter operation time [(43?9) minutes vs(69?17) minutes,t=-11.564,P=0.000].On the day after the operation,both the groups showed a stone clearance rate of 100%.No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [13.3%(6/45) vs 11.1%(3/27),?2=0.000,P=1.000).The patients were followed up for 1 to 24 months(mean,8 months),none of them developed ureteral stricture or recurrent stones during the period.Conclusion Both MPCNL and RLUL are safe,effective,and feasible for impacted upper ureteral calculi.