ABSTRACT
To analyze the effectiveness and safety of intermittent lung inflation combined with rigid ureteroscopy in the treatment of upper ureteral stones that were not fully visible. The clinical and imaging data of 56 patients with upper ureteral stone undergoing rigid ureteroscopic lithotripsy combined with intermittent lung inflation in Zhejiang Quhua Hospital from March 2016 to October 2017 were retrospectively analyzed.Intermittentt lung inflation was used to change and stabilize the position of ureteral calculi during the operation,so as to ensure the visual field of ureteroscopy.Holmium laser lithotripsy was performed to remove the stones.Urinary tract abdominal plain X-ray or CT urography was performed 1 and 3 months after the operation to evaluate the residual stones and the clinical efficacy. Stones were successfully removed after a single attempt in 48 patients.In 5 patients,stones escaped into the kidney during ureteroscopic lithotripsy,and thus flexible ureteroscopy were performed.In 3 patients,a second session of auxiliary procedure was required,among whom 2 patients received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy+ureteroscopic lithotripsy.The stone-free rates 1 and 3 months after surgery were 94.6%(53/56)and 100%(56/56),respectively.No severe complication such as ureter perforation,gross hematuria,septic shock,or pneumothorax occurred during and after surgery. Intermittent lung inflation in tracheal intubation under general anesthesia in patients with proximal ureteral stones that can not be fully visible during rigid ureteroscopic lithotripsy was feasible and reliable.It can effectively change the location of stones and thus enable safe and effective lithotripy.It expands the indications of rigid ureteroscopy for treating upper ureteral stones.
Subject(s)
Humans , Lithotripsy, Laser , Retrospective Studies , Ureteral Calculi , Diagnostic Imaging , Ureteroscopes , UreteroscopyABSTRACT
Objective To investigate the efficacy and safety of ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones.Methods The data of 32 patients diagnosed as renal or upper ureteral stones were retrospectively reviewed,who underwent ultra-mini percutaneous nephrolithotomy from June to October,2015,including 29 kidney stones,3 upper ureteral stones,of which 21 single stone,7 multiple stones,and 4 staghorn stones.There were 8 cases with inferior calyx stones,10 with renal pelvis stones,3 with upper ureteral stones,10 with renal pelvis stones plus inferior calyx stones and 1 with renal pelvis stones plus upper calyx stones.The mean stone size was (20.1 ±7.6) mm (ranging from 10 to 41mm).The mean Hounsfield unit (HU) was (1 125.9 ±225.9) Hu (ranging from 520 to 1 550Hu).In this cohort,13 cases had mild hydronephrosis,2 moderate hydronephrosis,1 severe hydronephrosis while no hydronephrosis identified in the other 16 patients.One case had concomitant kidney and ureter duplication malformation,and 1 case had residual stones after laparoscopic nephrolithotomy.Results All of the patients were treated by single tract UMP.Among them,middle calyceal puncture was performed in 9 cases,and the other 23 cases underwent lower calyceal puncture,including 4 cases of intercostal puncture,and 28 subcostal puncture.The mean operating time was (30.3 ± 15.0) min (ranging from 10 to 90 min).The mean postoperative hospital stay was (1.9 ± 1.0)days (ranging from 1 to 5 days).The mean hemoglobin decrease was(14.6 ±8.4)g/L (ranging from 1 to 46 g/L).No analgesics were used.Peri-operative complication rate was 3.13％ (1/32) with 1 case of collection system perforation.There was no fever,severe bleeding,urinary extravasation,pleural injury,or blood transfusion.The SFR was 93.75％ (30/32) and 96.88％ (31/32) on the first day and the first month after the operation,respectively.Conclusions UMP could be a safe and effective method for the treatment of renal or upper ureteral stones,especially for inferior calyceal stones less than 2cm.It offers high stone clearance rate,minimally invasiveness,quick recovery,short length of hospital stay and improved quality of life.
ABSTRACT
PURPOSE: Percutaneous nephroureterolithotripsy is one of alternative methods for the treatment of upper ureteral stones which are impacted in ureter or unresponsive to repeated extracorporeal shock wave lithotripsy(SWL). We evaluated the factors influencing the success rate of percutaneous nephroureterolithotripsy based on clinical data. MATERIALS AND METHODS: 107 patients(2 with bilateral) were included in this study. We reviewed the medical records and analyzed the factors ; stone size, laterality, location, site of percutaneous puncture, presence of pyuria, body weight, previous procedure(open surgery or SWL), and the experience of operator. RESULTS: The overall success rate of percutaneous nephroureterolithotripsy was 85.3%(93 of 109 cases). The location of stone and the experience of operator influenced the success rate of operation. The stones located above the lower pole level were obviously more successful than those located below it(57/62, 91.9% versus 36/47, 76.6%, p<0.05). In the late period of the operator`s experience, the success rate was significantly increased than that in the early period(51/58, 87.9% versus 40/51, 78.4%, p<0.05). But the stone size, laterality, site of percutaneous puncture, presence of pyuria, body weight and previous procedure didn`t influence the success rate. The average operation time was 93 minutes, average radiation exposure time was 2.2 minutes, and average hospital stay was 5.4 days. Most of the complications such as bleeding, urinary tract infection and pneumothorax were managed successfully with conservative treatments. CONCLUSIONS: Upper ureteral stones, which are impacted in ureter or unresponsive to repeated SWL can be successfully managed with percutaneous procedures. The stone location and the experience of operator are considered to be the major factors influencing the success rate.