Short-term ureteral catheter stenting after uncomplicated transurethral uretero-lithotomy

Short-term (1 or 2 post-operative days) ureteral catheter stenting after transurethral uretero-lithotomy (TUL) to avoid flank pain due to transient ureteral edema is described. Patients who underwent TUL for middle or distal ureteral stones with a rigid ureteroscope without complications during the procedures were the candidates for short-term ureteral stenting. An end-hole ureteral catheter, used to insert a guide wire during TUL, were used for stenting. The tip of the catheter was located near the renal pelvis and the other end was introduced outside through the urethra with a 14 F urethral catheter. The stent and catheter were removed on post-operative day 1 or 2. For the 18 patients treated using this method, the time of analgesic use after stent removal was 0.6±0.8, indicating a sufficient duration of stenting. Short-term ureteral catheter stenting is a cheap and easy way for post-operative management for uncomplicated TUL.     

Two years clinical experiences with extracorporeal shock-wave lithotripsy and transurethral ureterolithotripsy for ureteral stones at Osaka City University Hospital

From July 1985 to June 1987, 303 patients with ureteral stones were treated by either extracorporeal shock-wave lithotripsy (ESWL) or transurethral ureterolithotripsy (TUL). The ureteral stones were classified into two groups, upper and lower ureteral stones. The upper ureteral stone was defined as a stone located above the pelvic brim in radiological examinations. ESWL was performed using a Dornier lithotriptor HM-3. For TUL, following the insertion of a guide wire and dilatation of the intramural ureter by ureteral bougie, a ureteroscope was introduced into the ureter. The success rate included both patients who became stone free and patients whose stones were disintegrated into less than 4 mm. The success rate of ESWL for upper ureteral stones was 90%, and 8.5% were treated subsequently by TUL. The success rate of TUL for upper ureteral stones was 42%, and the remaining required another session of TUL or another procedure, mainly ESWL. On the other hand, the success rate of TUL for lower ureteral stones was 71%, and the remainder also required another session of TUL or another procedure, mainly ESWL. The efficacy of TUL for stone street was comparably low by the evaluation done at 5 days after the procedure. However, almost all patients with stone street, which had developed after ESWL treatment, became stone free several weeks after TUL and insertion of a stent catheter. Major complications or side effects for ESWL were fever of more than 37.5 degrees C (7.5%) and pain attacks (8.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Transurethral uretero-lithotripsy of ureteral stones in Osaka City University

During the 39 months since the introduction of transurethral lithotripsy (TUL) for the treatment of ureteral stones at our hospital in August 1985, TUL was performed a total of 200 times in 178 patients with ureteral stones. Among them, 111 patients had left ureteral stones and 65 had right ureteral stones, while 2 patients had ureteral stones in both sides. The stones were divided into upper ureteral stone (84 patients) and lower ureteral stone (94 patients) at above and below the iliac brim. 89% of the stones were less than 2 cm in diameter. Most of the patients were given lumbar anesthesia, and a guide wire was inserted into the ureter. The ureter was dilated with a ureteral bougie, and a 13F or 14F Storz ureteroscope was inserted. The stones were disintegrated by an ultrasound lithotripto and removed using forceps and a basket catheter. After the TUL procedure, a double J catheter was indwelled and removed within 5 days. The results were evaluated by DIP which was done 2 to 3 months after TUL. The success rate included residual stones less than 4 mm in diameter, as they could be spontaneously discharged. As a result, the success rate for upper ureteral stones was 53%, and it was higher for smaller stones. On the other hand, the success rate for lower ureteral stones was 85% and significantly higher. The main reasons for failure were the upper migration of the stones (60%) and inability to insert the ureteroscope up to the stone due to ureterostenosis and ureteral perforation (39%).(ABSTRACT TRUNCATED AT 250 WORDS)     

6/7.5 F输尿管镜联合输尿管导管负压吸引治疗输尿管上段结石216例报告

目的探讨应用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石的安全性及有效性。 方法回顾性分析深圳市前海蛇口自贸区医院2019年1月至2020年12月采用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引配合钬激光碎石治疗输尿管上段结石患者216例的临床资料。留置5 F输尿管导管越过结石上方,连接负压吸引,应用200 μm钬激光击碎结石。 结果216例患者中,术中共209例输尿管镜成功到达结石下方位置,上镜成功率96.8%;18例因整体或大部分结石移位至肾盂,一期行输尿管软镜碎石,结石上移率8.3%;术后低热5例,高热1例,感染率2.7%;拔管后20例KUB提示有>4 mm结石残留,清石率90.7%;所有病例均无输尿管穿孔、黏膜撕脱、感染性休克等严重并发症。 结论6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石安全、有效,可降低结石上移逃逸率,提高术后清石率,减少术后感染,临床效果确切。     

输尿管镜下阻挡网篮配合双频激光碎石术与ESWL治疗非复杂性输尿管上段结石疗效比较

目的：对体外震波碎石（ESWL）及输尿管镜下阻挡网篮配合双频激光碎石（URL）治疗非复杂性输尿管上段结石进行比较。探讨两种术式的疗效．方法：收治121例非复杂性输尿管上段结石病例。随机分两组．其中63例行ESWL-58例行URL,ESWL组采用多尼尔Cigma双定位体外冲击波碎石机,URL组采用Storz硬性输尿管镜,配用自制阻挡网篮,连接W．O．MU—100双频激光机后进行碎石,术后留置双J管。结果：两组在一次碎石成功率（ESWL93．7％、URI．93．1％）、术后1个月结石清除率（ESWI,90．4％．URI,93．1％）差异无统计学意义（P〈0．05）,治疗时间（ESWI．33．5±6．4、URL15．0±2．3）及术后1周结石清除率（ESWL69．8％、URL93．1％）URL组要优于ESWL组．差异有统计学意义（P〈0．05）。ESWI．组出现l例包膜下血肿。URL组出现1例输尿管穿孔．结论：对非复杂性输尿管上段结石的治疗,我们要根据患者具体情况及要求,科学地制定个体化治疗方案,以减少并发症。     

腔内弹道碎石治疗输尿管结石临床观察

目的：探讨输尿管镜下气压弹道碎石治疗输尿管结石的临床效果。方法：对252例输尿管结石患采用该法治疗的情况进行回顾分析。结果：252例中232例治疗成功,成功率为94.4％,8例输尿管镜放置失败,输尿管镜插入成功率为96.8％（244／252）,6例结石未能完全粉碎,腔内碎石成功率97.1％（238／244）。结论：输尿管镜下气压弹道碎石治疗输尿管结石疗效确切,患痛苦小,术后恢复快,是输尿管结石的较为满意的治疗方法。     

负压吸引鞘联合输尿管镜在输尿管上段结石中的应用

目的 研究负压吸引在输尿管上段结石中的应用价值。方法 选取自2017年4月1日至2017年7月31日本院泌尿外科收治的80例输尿管上段结石患者的临床资料。将患者从1～80进行编号，单号分入负压吸引组，双号分入普通硬镜组，每组各40例；比较两组患者碎石率、手术持续时间、术后发热情况、术中出血情况、术后住院天数。结果 两组患者年龄、性别分布、结石最大径、术前尿常规白细胞计数比较，差异均无统计学意义（P>0．05），术后分析手术一次清石成功率、手术持续时间、术后发热情况比较，负压吸收组均优于普通硬镜组，差异有统计学意义（P<0．05），且负压吸引鞘组能够在术中获得更加清晰的手术视野。两组患者在出血情况、术后住院天数方面，差异无统计学意义（P>0．05）。 结论 相对于普通硬镜，负压吸引鞘应用在输尿管上段结石中能在提高手术一次清石成功率的同时，能够缩短手术时间，减少术后发热情况的发生，手术视野受渗血影响较小，此外，负压吸引鞘组均保留结石标本，术后分析以指导患者长期饮食是一种安全、有效、经济、低风险的手术方法，值得广泛应用。     

Clinical results of transurethral ureterolithotripsy using pulsed-dye laser: primary ureteral stones versus secondary ureteral stones after ESWL

Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.     

改良截石斜仰卧位在输尿管镜治疗输尿管上段结石中的应用

目的 探讨改良截石斜仰卧位处理输尿管上段结石的可行性及疗效。方法 回顾分析2015年10月至2016年10月采用改良截石斜仰卧位使用输尿管硬镜治疗的45例输尿管上段结石患者的临床资料。结果 所有患者均成功进镜,40例顺利碎石成功,碎石成功率为88.9%。5例结石上移,其中2例在助手托举肾脏的帮助下顺利完成碎石,其中3例未能一期成功碎石。留置D-J管后术后辅助体外冲击波碎石均成功排石。结论 使用输尿管硬镜在处理输尿管上段结石时采用改良的Motola体位是安全有效的,可以提高碎石的成功率,是输尿管硬镜处理输尿管上段结石的理想体位。     

Clinical experience with Ureteromat in transurethral ureterorenoscopy

By September 1988, we performed 58 ureterorenoscopies (52 for primary ureteral calculi, 3 for ureteral biopsy, 2 for ureteral stricture and 1 for ureteral foreign body) using a Ureteromat (Uromat Storz, West Germany). Continuous saline irrigation with the Ureteromat has obviated mechanical dilation of the ureteral orifice in 93.1% of the cases, which made this endoscopy as easy as the conventional cystourethroscopy. In 4 cases (6.9%), however, balloon dilation of the ureteral orifice was necessary for the passage of a rigid ureterorenoscope. Of 52 ureteral calculi, 37 were assigned for transurethral ureterolithotripsy (TUL), whereas transurethral ureterorenoscopy (TUURS) was indicated to flush the remaining 15 calculi up into renal pelvis for later extracorporeal shock wave lithotripsy. TUL was successful in 81.1% (30/37). The causes of failure were stone migration in 6 cases and ureteral avulsion by electrohydraulic lithotripsy necessitating open surgery in 1 case. The irrigation with the Ureteromat facilitated the manipulation of intraluminal ureteral lesions always under clear vision; by-passing the impacted stone with a guide wire and flushing-up of the calculi were successfully performed in 100%, in spite of the co-existing edematous and inflammatory mucosal changes. In 7 cases where ureteroscope could not be advanced well up to the lesion because of spasm in the iliac ureter, the irrigation pressure was transiently increased up to 200 mmHg to allow safe and easy dislodgement of impacted calculi under fluoroscopic guidance. This procedure was also effective to introduced a ureteral stent over a guide wire in 2 cases of ureteral stricture, which could not be achieved by conventional cystoscopic procedure. Immediate postoperative complications were fever in 8.6% and gross hematuria lasting for more than 4 days in 8.6%.(ABSTRACT TRUNCATED AT 250 WORDS)     

三种微创术式治疗复杂性输尿管上段结石的疗效分析

目的 探讨输尿管软镜钬激光碎石(FURS)、微创经皮肾取石术(MPCNL)及腹腔镜输尿管切开取石(LU)三组微创术治疗复杂性输尿管上段结石的疗效.方法 回顾性分析本院2010年1月至2014年1月收治复杂性输尿管上段结石患者285例,根据所行术式,分为三组,FURS组58例,MPCNL组109例及LU组118例,观察三组患者的手术时间、术后住院时间、住院费用、术后D-J管留置时间、术后3d净石率、术后1个月净石率、术后辅助体外冲击波(ESWL)治疗例数、术后并发症发生率.结果 三组患者复杂性输尿管上段结石术后3d的净石率分别为98.3％(FURS组)、88.1％(MPCNL组)、94.4％(LU组),其中MPCNL组术后3d的净石率较低,明显低于FURS组(P＜0.05),而三组患者的术后1个月净石率比较无明显差异(P＞0.05);与FURS组患者相比,MPCNL组及LU组患者的手术时间、住院时间明显增加,住院费用明显较少,术后并发症发生率较高,差异有统计学意义(P＜0.05);与MPCNL组患者相比,LU组患者手术时间(69.32±6.05) min较短,术后需ESWL辅助处理率(1.7％)更小,术后并发症发生率(3.6％)较低;而三组患者在术后D-J留置时间方面无明显差异(P＞0.05).结论 复杂性输尿管上段结石的治疗可根据患者的综合情况,选择合适而理想的个体化微创治疗方案,而输尿管软镜钬激光碎石治疗具有碎石效率高、安全的优势,值得临床进一步推广应用.     

钬激光腔内碎石术治疗输尿管、膀胱结石

目的 探讨经输尿管肾镜或膀胱镜下钬激光碎石术治疗输尿管、膀胱结石的疗效。方法 我科2002年12月～2004年11月，经输尿管肾镜或膀胱镜下钬激光治疗输尿管、膀胱结石322例。直接经尿道插入F8/9.8输尿管镜或F22膀胱镜，直达结石位置，自镜身操作腔道插入光纤，激发激光粉碎结石至3mm以下，合并息肉或狭窄者汽化切割或切开，术毕常规留置导尿管1～3d，留置双J管2～6周拔除。行钬激光前列腺剜除术（holmium laser enucleation of the prostate，HoLEP），或经尿道前列腺电切术（transurethral resection of the prostate，TURP），或经尿道前列腺汽化电切术（transurethral vaporization of the prostate，TUVP）的病例，留置三腔气囊导尿管压迫前列腺窝，1周后拔除。结果11例膀胱结石一次性碎石成功；311例输尿管结石，单次碎石成功率97．1％（302／311）。手术时间10～150min，平均38min。术中输尿管黏膜出血22例，无输尿管穿孔、撕裂等并发症。术后6例发热（1．9％）。肉眼血尿时间1～3d。术后住院1～5d，平均3．2d；术后结石排净时间14～35d，平均28d。结论 通过腔道钬激光碎石术治疗泌尿系结石安全、高效。     

Clinical experience with extracorporeal shock wave lithotripsy MFL-5000 for urinary stone

A Dornier MFL 5000, a new generation extracorporeal shock wave lithotripter, was installed in our hospital and the first Japanese clinical experience has been collected between July and November in 1989. We report our experience with the first 35 patients with 45 stones who were treated in 42 treatments using ESWL. We followed up 3 weeks. No invasive anesthesia was performed except 2 cases of epidural anesthesia. A double J catheter was installed in 2 patients, a ureteral catheter in 4 patients, and PNL was performed in 2 patients before ESWL. We did not use a PNL or a TUL in the postoperative treatment. In the 3 week followed up period, 29 patients (82.9%) were completely free from stone fragments. No serious complications were observed after ESWL. We conclude that the DORNIER MFL 5000 is effective for renal and ureteral stones without serious complications.     

硬性输尿管镜碎石困难的原因分析及对策

目的探讨硬性输尿管镜下碎石术中常见困难的原因与相应处理。方法回顾分析19例2004年3月～2006年12月应用F8/9.8硬性输尿管镜钬激光或气压弹道碎石术治疗输尿管结石术中操作困难的临床资料。输尿管入口狭窄造成硬镜置入困难3例,结石梗阻严重合并输尿管炎性息肉包裹导致碎石困难6例,因输尿管各段狭窄而输尿管镜上行困难6例,输尿管扭曲成角导致输尿管镜上行困难4例。结果15例经调整手术方法、改变灌注泵压力、狭窄段内切开等方法碎石成功;2例输尿管全程狭窄,留置双J管后行体外冲击波碎石治疗;2例碎石失败,行经皮肾镜碎石后取净结石。4例出现并发症:2例输尿管穿孔,2例输尿管黏膜撕脱。其中1例中转开放手术,余3例保守治疗后痊愈。结论硬性输尿管镜钬激光或气压弹道碎石术治疗输尿管结石是安全有效的,熟悉输尿管的解剖特点,熟练掌握手术操作技巧,可以提高碎石成功率。     

2μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石

目的 探讨输尿管镜下2μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石的安全性和有效性.方法 2007年6月至2010年3月收治肉芽包裹性输尿管结石38例.男20例,女18例.平均年龄47(21～76)岁.左侧17例,右侧21例.肾积水中度24例,重度14例.肾盂分离平均3.8(2.1～7.2)cm.输尿管硬镜下,先用2 μm激光汽化切除结石下方炎性肉芽,显露结石,再用EMS碎石清石系统碎石,统计分析碎石率、排石率和并发症.结果 原位碎石成功35例(92%).碎石时间平均(23.0±6.5)min;术中出血量平均(7.0±4.5)ml;术后住院时间平均(5.2±0.6)d.2例结石上移至肾盂,留置支架管后辅以ESWL碎石,1例输尿管狭窄置镜失败改开放手术.术后1个月复查,结石排净32例(86%),平均随访8(3～15)个月,未出现输尿管狭窄,尿路感染等并发症.结论 输尿管镜下2 μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石安全、高效,可作为这类病例的首选治疗手段.     

低压灌注技术在输尿管镜钬激光碎石术中的临床价值分析

目的:探讨输尿管导管外引流及手持针筒注水等低压灌注技术在输尿管镜钬激光碎石术中的临床应用价值,分析其可行性、实用性及临床疗效。方法:选取2019年2月至2020年1月在本院行输尿管镜下钬激光碎石术的12例输尿管结石患者为研究对象,根据术中灌注方式将其分为低压灌注组和普通灌注组。低压灌注组在输尿管导管外引流及手持针筒注水...     

输尿管中下段结石并感染的内镜治疗

目的:探讨输尿管中下段结石并感染的内镜治疗方法.方法:回顾性分析33例输尿管中下段结石并感染患者的临床资料,采用一期导管旁输尿管镜气压弹道碎石术治疗21例;先期行经皮肾造瘘,二期行输尿管镜碎石取石术12例.结果:施行一期输尿管镜碎石术的21例患者中,2例术中改为经皮肾穿刺造瘘,2例术后出现不同程度的发热和肾区胀痛.施行经皮肾造瘘后二期输尿管镜碎石取石术的12例患者中,无一例术后出现发热及肾区胀痛.结论:对于输尿管中下段结石并感染患者,如血常规正常、肾积水较轻且B超透声好、体温正常,可行导管旁输尿管镜气压弹道碎石术;而对于血常规指标高、肾积水重且B超透声差、伴发热者,应先期行经皮肾造瘘,二期行输尿管镜碎石取石术.     

双“D-J”管在预防复杂性输尿管结石钬激光碎石术后狭窄的应用

目的探讨复杂性输尿管结石钬激光碎石术后留置双“D-J”管对预防术后狭窄的临床疗效。方法选取我院2018年6月~2019年6月收治的因复杂性输尿管结石行输尿管镜钬激光碎石治疗的80例患者,采用随机数字法分为研究组(n=40例)及对照组(n=40例),于钬激光碎石术后分别留置双“D-J”管和单根“D-J”管。比较两组患者手术时间、腰痛数字评分、膀胱刺激症、肉眼血尿、结石残留率、输尿管狭窄发生率等指标。结果两组患者手术时间及膀胱刺激症、腰痛评分、血尿、发热等带管期间并发症比较,差异均无统计学意义(P>0.05);拔管4周后两组结石清除率比较,差异亦无统计学意义(P>0.05);拔管后研究组输尿管狭窄发生率为5%,明显低于对照组的22.5%,差异有统计学意义(P<0.05)。结论对于复杂性输尿管结石患者,放置双“D-J”管可有效减少输尿管狭窄的发生,并对带管期间并发症和结石清除率无影响。     

Lesiones relacionadas con la vaina de acceso ureteral frente a infecciones postoperatorias. ¿Es siempre necesaria la inserción de la vaina de acceso? Estudio prospectivo aleatorizado para comprender las luces y sombras de esta práctica

ObjectiveTo compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion.Patients and methodsIn this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication.ResultsThe evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = .03).ConclusionsUAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections.Clinical Trial Registration Number (ISRCTN registry number): 55546280.     

Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones]

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)