Application of ureteral access sheath with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones / 实用医学杂志

Objective To investigate the safety and efficacy of ureteral access sheath (UAS) with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones.Methods The clinical data on 56 patients with infectious renal stones who received flexible ureteroscopic lithotripsy were retrospectively analyzed.The patients were randomly divided into group A (26 patients) and group B (30 patients).Intrapelvic pressure,stoneclearance rate,surgical duration,formation of steinstrasse,postoperative fever (temperature ＞ 38.5 ℃C),PCT,leukocyte count,length of hospital stay,and hospitalization cost were evaluated.Results Intrapelvic pressure was much lower in group A than in group B;stone clearance rate was 96.2％ for group A and 83.3％ for group B;and surgical duration was (80.1 ± 2.2) min and (105.2 ± 3.5) min,respectively.One patient developed steinstrasse and one had postoperative fever in group A,while six patients developed steinstrasse and 4 had postoperative fever in group B;PCT and leukocyte count was much lower in group A than in group B.There were statistical differences between the two groups (P ＜ 0.05).The length of hospital stay and hospitalization cost were (7.4 ± 0.8)d and (20857.1 ± 389.4) RMB for group A and (8.2±1.3)d and (22008.5±394.3) RMB;but there were no statistical differences between the two groups (P ＞ 0.05).Conclusions Application of ureteral access sheath with vacuum suction during flexible ureteroscopic lithotripsy in the treatment of renal stones was safe and effective.It can shorten surgical duration,improve stoneclearance rate and reduce incidence of adverse reactions.This procedure has better value of clinical application.

Comparison of minimally invasive percutaneous renal stone removal in diabetic patients and non-diabetic patients / 实用医学杂志

Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with diabetes mellitus and non-diabetic patients. Methods A retrospective analysis was performed to look into the clinical data of 2,796 patients undergoing downward F18minimally invasive percutaneous nephrolithotomy during May 2007 to June 2016 under X-ray guidance Among them,582 diabetic patients were assigned as the diatetes group,aged 26-82 years,279 male,303 female, 174 with pelvic stones,255 with multiple calculi,153 with staghorn calculi,fasting blood glucose 5.4~20.3 mmol/L,postprandial and 2 hours blood glucose 9.1~28.9 mmol/L. In the group,the results of preoperative fasting blood glucose,glycosylated hemoglobin,meal 2 hours blood glucose,diabetes mellitus immune and two others,were in line with diabetes diagnosis and typing standard, and the stones were tested by infrared spectrum analyzer for determination of chemical composition(P0.05),but the hospital stay in the diabetic group was significantly longer than that of the control group. In comparison of the stone compositions,therate of uric acid stones in the diabetic group was significantly higher than that of the control group (P < 0.05). Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of renal calculi in patients with diabetes mellitus. Diabetic patients are susceptive to uric acid stones and those patients at the poor control of blood glucose suffer from a higher recurrence of renal stones , which reminds the importance of doctors to educate the patients on the prevention of kidney stones.

Diagnosis and treatment of perirenal hematoma associated with ureteral flexible lithotripsy / 实用医学杂志

Objective To explore the risk factors ,prevention and treatment of the occurrence of perirenal hematoma after flexible lithotripsy. Methods We retrospectively analyzed the clinical data of 18 patients with symptomatic perirenal hematoma from 1259 who had undergone ureteral flexible lithotripsy in our hospital during the period of April 2007 to April 2016. Of the 18 patients,7 were complicated with diabetes mellitus,11 had urinary tract infection;15 were female,and 3 were male. Results Perirenal hematoma was confirmed by B ultrasound and CT,which situated on the Posterolateral side of the kidney in 8 patients,and on the lower pole and abdominal side in 10. Hematoma depth was 2.6-15.3 cm(average was 5.2 cm). The hematoma?related symptoms gradually disappeared in 11 patients 7 to 14 days after they received conservative treatment. 5 recovered gradually 15 days after undergoing hematoma puncture and drainage ,and 2 recovered 36 days after receiving open surgery for removal of hematoma. Conclusions Female,diabetes,urinary tract infection,bigger stone size,prolonged surgical duration,and infected stones were the risk factors for perinephric hematoma related to ureteroscopic lithotripsy. Full preoperative preparation ,effective anti?infection ,intraoperative improvement of calculus?breaking skills and use of large caliber semirigid through sheath,low pressure perfusion,shorter surgical duration,and staging surgery are effective ways to reduce the occurrence of perirenal hematoma.

Comparison of double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy for lithotripsy / 中国内镜杂志

Objective To compare the efficiency and safety of double-channel flexible ureteroscopy and electronic flexible ureteroscopy.Methods From April 2007 to 2016 July, clinical data of 836 cases flexible ureteroscopic holmium laser lithotripsy were collected. All the patients were randomly divided into electronic lfexible ureteroscopy group (n = 427) and double-channel lfexible ureteroscopy group (n = 409), the operation time, success rate of surgery, complications, residual stone rate of the two groups were compared.Results The success rate of surgery was 92.5% and 83.6% of the two groups respectively, the difference was significant (P 0.05); the average operation time was (81.1 ± 7.9) min and (95.3 ± 7.6) min respectively, the difference was significant (P 0.05).Conclusion Both double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy are effective and safe therapeutic modalities. Electronic flexible ureteroscopy is better than double-channel lfexible ureteroscopy in success rate of surgery because of its high deifnition and lfexible operation.

Comparative analysis of transabdominal preperitoneal prosthetic and tension-free hernioplasty in treatment of incarcerated hernia / 中国医师进修杂志

Objective To investigate the security and validity of transabdominal preperitoneal prosthetic (TAPP) in treatment of incarcerated hernia.Methods One hundred and twenty-four patients with incarcerated hernia were divided into 2 groups by random pair method:observation group with treatment of laparoscopic reposition and TAPP (56 cases) and control group with treatment of open reduction and tension-free hernioplasty (68 cases).The operative time,hospital stay,bed time,hospital costs,recurrence rate and complication were compared between the 2 groups.Results All patients in observation group were received laparoscopic surgery successfully.The operation time,hospital stay,bed time in observation group were significandy shorter than those in control group [(37.52 ± 7.78) min vs.(44.23 ± 11.32) min,(4.53 ± 0.89) d vs.(6.85 ± 2.03) d,(9.30 ± 2.65) h vs.(12.63 ± 3.97) h],there were statistical differences (P ＜0.05).The hospital costs in observation group was significandy higher than that in control group [(9 324 ± 599) yuan vs.(7 203 ± 507) yuan],there was statistical difference (P ＜ 0.05).There was no statistical difference in complication rate between the 2 groups (P ＞ 0.05).Follow-up 1 year,there was no recurrence patient in observation group and 1 patient was recurrence in control group,there was no statistical difference between the 2 groups (P ＞ 0.05).Conclusions TAPP is safe and effective with advantages of mini-invasion,quicker recovery but more hospital costs in treatment of incarcerated hernia.The recurrence rate of TAPP is similar to tension-free hernioplasty.

Minimally invasive nercutaneous nephrolithotomy combined with negative pressure system in one-stage treatment of calculus pyonephrosis / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy combined with negative pressure system in one-stage treatment of calculus pyonephrosis.Methods Eighty-three cases of calculus pyonephrosis,including 15 upper ureteral calculus cases,9 renal pelvis calculus cases,28 multiple calculus cases and 31 staghorn calculus cases,were retrospectively analysed.The diameter of the stone was from 1.2 to 6.3 cm.All the patients were punctured under X-ray or ultrasound guidance and established an access of 20 F.A 12 F nephroscope,combined with negative pressure system,was inserted to the collecting system to suck off the liquor pus.The stone was fragmented by pneumatic lithotripsy or holmium laser lithotripsy at one-stage.Negative pressure system was used to reduce the intrapelvic pressure during the operation.Results All the patients were treated successfully.The average operative time was 34 ± 19 min.The upper ureteral calculus and renal pelvis calculus cases were all stonefree at one-stage treatment.Of the other 59 cases,33 cases were stone-free and 26 cases need a secondlook.The total stone free rate was 68.7％(57/83)at one-stage and 91.6％(76/83)at second-look.Only 7 patients had fever after operation and no patient had sepsis or shock.Conclusion Combined with negative pressure system,minimally invasive percutaueous nephrolithotomy via a 20 F tract is safe and effective for one-stage treatment of calculus pyonephrosis.

Endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys / 中华泌尿外科杂志

Objective To report the clinical outcomes of applying endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys. Methods Between February 2001 and April 2008, 13 men and 5 women with ureterovesical anastomotic site obstruction in their transplanted kidneys were treated by endoscopic incision with electrocautery or holmium: YAG laser. After the anastomosis was completely resected, two Double-J stents were placed in the ureter for 6-8 weeks. During follow-up, renal function, ultrasound examination and wash-out renal scintig-raphy were performed every month for the first 6 months, then every 3 months. Results Total 25 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. No complication was recorded during or after the procedure. At the mean follow-up of 51 months (range 4-90 months), 5 patients presented with recurred obstructive uropathy immediately after the Double-J stent removal and finally underwent open surgical correction. Conclusions Endo-scopic incision is safe and effective in the treatment of ureterovesical anastomosis site obstruction in transplanted kidney. However, open surgical reconstruction should be considered if endoscopic inci-sion procedure has failed.

The influence of minimally invasive percutaneous nephrolithotomy on renal pelvic pressure in vivo.

OBJECTIVE: To inspect the renal pelvic pressure during minimally invasive percutaneous nephrolithotomy (MPCNL) and to investigate whether the use of the 14 to 18-Fr percutaneous tract, 8/9.8-Fr rigid ureteroscope, and a perfusion with high pressure furnished for MPCNL results in high renal pelvic pressure. PATIENTS AND METHODS: Between July 2005 and February 2006, 76 patients were selected for renal pelvic pressure measurement during MPCNL. The renal pelvic pressure was measured by a baroceptor of the invasive blood pressure channel in a MAIDRAY PM9000 monitor, which was connected to the open-ended ureteric catheter indwelled in the renal pelvis retrogradely. The computer collected the renal pelvic pressure data each second and all the data were evaluated statistically with SPSS 12.0 software. RESULTS: During MPCNL within the 14, 16, 18, and double-16-Fr percutaneous tracts, the average renal pelvic pressures were 24.85, 16.23, 11.68, and 5.8 mm Hg, respectively. The average lasting times of renal pelvic pressure >/=30 mm Hg were 283, 96, 44, and 10 seconds, respectively. A postoperative fever >/=38 degrees C was recorded in 2 (2/12), 3 (3/30), 2 (2/21), and 1 case (1/13), respectively. CONCLUSIONS: Renal pelvic pressure generally remains lower than the level required for a backflow (30 mm Hg), during MPCNL via 14 to 18-Fr percutaneous tract. Any factor, which causes bad drainage, will result in a temporarily elevated renal pelvic pressure greater than 30 mm Hg; and multiple temporary high-pressure episodes can have a cumulative effect, which means that there will be enough backflow to cause a bacteremia.

Analysis of the cause of hemorrhage after MPCNL and its interventional treatment / 中华泌尿外科杂志

Objective To analyze the cause of delayed hemorrhage after minimally invasive percu- taneous nephrolithotomy(MPCNL),and to summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization.Methods The clinical data of 3812 cases of MPCNL from June 1998 to July 2004 were reviewed.Of them,12 patients(11 men and 1 woman;mean age,45 years)who developed severe hemorrhage after MPCNL were identified.The cause of hemorrhage and the treatment results were analyzed.Results The rate of delayed hemorrhage after MPCNL was 0.31% (12/3812).The mean time to onset of severe bleeding was 10 d after MPCNL.Renal arteriography was per- formed in all 12 patients,showing 5 arteriovenous fistulas and 7 false aneurysms.Superselective arteriolar em- bolization for hemostasis was performed in all 12 cases.All these vascular abnormalities were successfully treated by superselective embolization.Follow-up showed that the hematuria disappeared and renal function recovered well.Conclusions Severe hemorrhage following MPCNL is a rare complication,the incidence of which is significantly lower than that of conventional PCNL.The cause is mainly the arteriolar injury of re- nal puncture passage.Superselective embolization provides effective control of bleeding and currently consti- tutes the treatment of choice based on our experience.