ABSTRACT
OBJECTIVE@#To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones.@*METHODS@#The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function.@*RESULTS@#In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%.@*CONCLUSION@#This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.
Subject(s)
Adult , Humans , Middle Aged , Kidney Calculi , Nephrolithotomy, Percutaneous , Retrospective Studies , Solitary Kidney/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To evaluate the long-term efficacy of tension-free vaginal tape (TVT)and trans-obturator tape (TOT)for different types of female stress urinary incontinence (FSUI).@*METHODS@#The clinical data of all female patients with stress urinary incontinence (SUI) who underwent mid-urethral slings (MUS) in Peking University People's Hospital from January 2008 to June 2016 were retrospectively analyzed, and all the patients were followed up. Based on the level of abdominal leak point pressure (ALPP), the patients with ALPP lower than or equal to 60 cmH2O (1 cmH2O=0.74 mmHg) were regarded as intrinsic sphincter deficiency (ISD) type, and the patients with ALPP higher than 60 cmH2O were regarded as non-ISD type. According to the degree of remission of leakage of urine by using the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), the surgical outcomes were divided into three categories: cured, improved or failed. The efficacy of TVT and TOT for different types of FSUI was evaluated by comparing the cure rate of TVT with the cure rate of TOT in ISD type and non-ISD type separately.@*RESULTS@#A total of 170 patients were included in this study. The patients were among 30-78 years, and the follow-up period were among 12-110 months. In the study, 117 patients belonged to non-ISD type. Of whom 30 underwent TVT with a cure rate of 86.7% (26/30), and the other 87 underwent TOT with a cure rate of 69.0% (60/87). The cure rate of TVT was higher than that of TOT in non-ISD type, however, Chi-square test showed that there was no significant difference (χ2=3.589, P>0.05). In addition, 53 patients belonged to ISD type, of whom 16 underwent TVT with a cure rate of 87.5% (14/16), and the other 37 underwent TOT with a cure rate of 51.4% (19/37). The cure rate of TVT was higher than that of TOT in ISD type, and Chi-square test showed that the difference was statistically significant (χ2=6.212, P<0.05).@*CONCLUSION@#For the treatment of FSUI, MUS can achieve satisfactory long-term efficacy. For non-ISD type, the cure rates of TVT and TOT are similar, while for ISD type, the cure rate of TVT is higher than that of TOT.