两种腔内技术治疗前列腺增生并膀胱结石的比较

目的：比较经尿道单通道气压弹道碎石联合经尿道前列腺电切术（TURP）（单通道手术）与经皮膀胱造瘘通道和尿道双通道气压弹道碎石联合TURP（双通道手术）治疗前列腺增生（BPH）并膀胱结石的疗效.方法：回顾性分析25例单通道手术与25例双通道手术患者的临床资料.结果：两组患者术后下尿路梗阻症状均解除,术后留置尿管时间、膀胱冲洗时间及术后住院时间无明显差别,TURP时间基本相同;但在碎石清石时间、残石存留及尿道狭窄的发生上,双通道手术优于单通道手术.结论：经皮膀胱造瘘通道和尿道双通道气压弹道碎石联合TURP治疗BPH并膀胱结石比单通道手术更具有安全性和有效性.     

肾镜EMS气压弹道联合超声碎石清石系统经耻骨上膀胱造瘘治疗大膀胱结石（附13例报告）

目的：探讨简便、有效的治疗大膀胱结石的微刨治疗方法。方法：大膀胱结石患者13例,均为男性,平均年龄64（53～83）岁。并发下尿路疾病：前列腺增生或膀胱颈纤维化6例,尿道狭窄3例,长期留置耻骨上膀胱造瘘管4例。平均结石大小3．6（2．5～6．5）cm。均使用EMS气压弹道联合超声碎石清石系统经耻骨上膀胱造瘘治疗。结果：全部患者大膀胱结石均一次清除干净,平均手术时间35（15～65）min。结论：肾镜EMS气压弹道联合超声碎石清石系统经耻骨上膀胱造瘘治疗大膀胱结石具有简便、高效、微创的特点,临床易于推广。     

经尿道前列腺汽化电切术联合经皮膀胱穿刺造瘘气压弹道碎石治疗前列腺增生合并膀胱结石

目的探讨经尿道前列腺汽化电切术（transurethral resection of prostate,TURP）联合经皮膀胱穿刺造瘘气压弹道碎石治疗良性前列腺增生（benign prostate hyperplasia,BPH）合并膀胱结石的效果。方法 2008年1月～2011年1月,采用TURP联合经皮膀胱穿刺造瘘肾镜下气压弹道碎石术治疗BPH（50～80 g）合并膀胱结石（2.5～5.0 cm）33例。结果 33例均一次手术成功,无输血、电切综合征及严重感染等并发症发生。术后1周复查KUB,膀胱内均未见残石。住院时间7～12d,平均9 d。术后1个月最大尿流率18～26 ml/s,平均20 ml/s。结论 TURP联合经皮膀胱穿刺造瘘气压弹道碎石治疗BPH合并膀胱结石,创伤小,手术时间短,恢复快,是治疗BPH合并膀胱结石的安全高效的方法。     

B膀胱造瘘改良法治疗膀胱大结石

目的：探讨膀胱造瘘加自制水封（防水帽）经电切镜外鞘输尿管镜气压弹道碎石联合大力碎石钳碎石治疗膀胱大结石（〉2．5cm）的疗效。方法：膀胱造瘘下经尿道置入电切镜外鞘,套上自制水封,输尿管镜经水封沿电切镜外鞘气压弹道碎石联合大力钳碎石治疗膀胱大结石35例,22例合并BPH,其中有18患者同期干亍经尿道前列腺电切术（TuRP）。结果：患者均一次碎石成功,无严重出血、严重尿外渗、尿道假道、膀胱破裂等并发症发生,无一例中转开放手术。术后随访3～13个月,无远期并发症。结论：该方法具有安全可靠、损伤小、手术时间短、并发症少、适应证广的优点。     

前列腺增生并膀胱结石的腔内治疗

目的：探讨经尿道前列腺电切术（TURP）结合气压弹道碎石术治疗良性前列腺增生（BPH）并膀胱结石的疗效。方法：采用TURP结合气压弹道碎石术治疗40例BPH并膀胱结石患者,并分析其疗效。结果：所有患者均一次处理成功,除20例有膀胱粘膜散在充血外,无膀胱穿孔等并发症,术后复查最大尿流率均＞15．0ml/s。结论：TURP结合气压弹道碎石术是治疗BPH并膀胱结石的一种安全、高效的方法。     

输尿管镜气压弹导碎石术治疗儿童下尿路结石

目的：探讨儿童下尿路结石的治疗方法。方法：应用输尿管镜气压弹导碎石术经尿道或膀胱穿刺造瘘通道治疗儿童下尿路结石22例。结果：22例均一次成功击碎结石，治愈率100％。其中2例经膀胱穿刺造瘘通道碎石，术中即将结石取净。20例经尿道膀胱内碎石，术后结石均排净。无一例有并发症。结论：输尿管镜下气压弹导碎石治疗儿童下尿路结石，创伤小，成功率高，并发症少，为一种较理想的治疗方法。     

前列腺增生合并膀胱结石的微创治疗

目的 总结前列腺增生(BPH)并膀胱结石的治疗方法及疗效.方法 回顾性分析112例BPH合并膀胱结石患者的临床资料及随访结果.结果 分别采用一期电切环直径勾出(11例)、大力碎石钳碎石(15例)、耻骨上经膀胱气压弹道碎石(9例)、经尿道气压弹道碎石(31例)、耻骨上小切口取石(24例)同期联合经尿道前列腺电切(TURP)和体外超声波碎石(ESWL)后TURP(22例)治疗.所有患者均一次性治疗成功,术中无膀胱及尿道穿孔、无发生经尿道电切综合征、输血及中转开放手术病例,无结石残留;术后6个月国际前列腺症状评分(IPSS)和最大尿流率(MRF)较术前有显著改善,无尿道狭窄及迟发出血等.结论 各种微创治疗均安全、满意.方法 选择应根据患者具体情况及结石大小综合分析,结合医疗条件及术者技能,采取个体化治疗措施.     

经尿道肾镜联合电切镜鞘气压弹道超声碎石清石术在膀胱结石的临床应用

目的 探讨经尿道肾镜联合电切镜鞘气压弹道超声碎石清石术治疗膀胱结石的临床疗效和安全性.方法 回顾性分析采用经尿道肾镜联合电切镜气压弹道超声碎石清石术治疗的34例膀胱结石患者的临床资料,所有患者均经尿道置入F20肾镜,结石大于4 cm可行膀胱造瘘,采用瑞士第四代EMS气压弹道碎石清石系统进行碎石,应用电切镜鞘Ellick冲洗器冲出碎石和肾镜下超声探杆清石,术后留置导尿2～3d.结果 34例患者均手术成功,一次性将膀胱结石去除,无一例中转传统开放性手术,碎石时间8 ～ 45 min,术中术后无膀胱穿孔、大出血、尿道狭窄、急性附睾炎、膀胱痉挛等并发症.结论 经尿道肾镜联合电切镜气压弹道超声碎石清石术治疗膀胱结石是目前疗效确切、适应证广且效率较高的一种有效方法,值得临床上推广应用.     

经膀胱气压弹道碎石和前列腺电切同期治疗巨大前列腺增生并膀胱结石

前列腺增生常并发膀胱结石，临床上常采用经尿道碎石同时行前列腺电切，但是对于巨大的良性前列腺增生(BPH)伴膀胱结石患者，经尿道碎石取石困难。我院自2002年8月～2004年6月同期行耻骨上经膀胱气压弹道碎石和经尿道前列腺电切(TURP)治疗23例巨大前列腺增生并膀胱结石患者，取得满意效果，现报告如下。     

经尿道电切镜鞘气压弹道碎石术治疗膀胱结石

目的探讨经尿道电切镜鞘气压弹道碎石术治疗膀胱结石的疗效。方法2003年3月~2007年5月,采用经尿道电切镜鞘气压弹道碎石术治疗膀胱结石32例。结果32例均一次手术成功,无中转开放手术。22例合并前列腺增生症碎石后行经尿道前列腺电切术(transurethral prostatectomy,TURP),4例膀胱颈挛缩行膀胱颈电切术,4例尿道狭窄入镜前行尿道扩张,2例单纯行膀胱结石碎石。手术时间25~90min,(45±25)min,均无结石残留,无膀胱穿孔。术后尿道狭窄1例。结论经尿道电切镜鞘输尿管肾镜气压弹道碎石术治疗膀胱结石具有方法可靠、创伤小、手术并发症少等优点,特别适合于合并前列腺增生者。     

Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country

OBJECTIVE: To evaluate our experience with percutaneous suprapubic cystolithotripsy (PCCL) in Yemeni children with endemic urinary bladder stones. PATIENTS AND METHODS: Between January 1993 and December 1998, 117 children underwent percutaneous suprapubic lithotripsy in Arabia Felix Modern Hospital, Sana'a Republic of Yemen. The patients' ages ranged from 8 months to 14 years (average 3.7 years). Ninety patients (77%) were under 5 years old; 20 patients (16%) were between 6 and 10 years old, and 7 patients (6%) were between 11 and 14 years old. There were 116 boys and 1 girl. The stone size ranged from 0.7 to 4 (average 2.3) cm. Five patients had coexisting urinary bilharziasis and another 5 patients had coexisting renal stone. In 10 patients, the stone was in the urethra. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was an adult 26-french nephroscope, the same as that used for percutaneous nephrolithotripsy. Ultrasound disintegration was needed for stones of > 1 cm. A suprapubic catheter was left for 24 h, and a urethral catheter was kept for 48 h. RESULTS: All patients became stone free. The average operating time was 15 (5-50) min. The average hospital stay was 2.7 (2-5) days. No severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 109 patients (93%). CONCLUSION: Based on our experience we can conclude that percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. Our series proves the nutritional etiology of endemic pediatric bladder stones. To our knowledge, this is the largest series reported on percutaneous suprapubic management of endemic bladder stones in children.     

Percutaneous suprapubic cystolithotripsy for vesical calculi in children.

BACKGROUND: The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations. PATIENTS AND METHODS: Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours. RESULTS: All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access. CONCLUSION: Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.     

Per-urethral endoscopic management of bladder stones: does size matter?

Large urinary bladder stones occupying the whole lumen are still encountered. Conventionally, an open suprapubic cystolithotomy (SPCL) has been the accepted treatment of choice. The other method described is suprapubic percutaneous lithotripsy. The present paper describes complete stone clearance in adults by the urethral route using a conventional nephroscope, a pneumatic lithotripter, and an evacuator. An additional procedure to treat outlet obstruction is performed when required. Although the procedure takes a long time, stone clearance is complete, and the procedure is free from any complications. This technique should be offered to all adults, as it has negligible morbidity.     

Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi

BACKGROUND AND PURPOSE: The treatment options available for managing bladder calculi include transurethral cystolithotripsy, open cystolithotomy, and shockwave lithotripsy. For larger calculi, transurethral treatment can be time consuming, and the manipulation has the potential to cause urethral injury. Percutaneous suprapubic cystolithotripsy represents another treatment option for bladder calculi which is effective and minimally invasive. PATIENTS AND METHODS: Fifteen patients had bladder calculi treated with percutaneous cystolithotripsy over a 3-year period. The mean stone size was 39 mm (range 10-64 mm). Stones were single in seven patients and multiple in eight patients. The indications for cystolithotripsy were stone size >3 cm, multiple stones >1 cm, and inability to perform transurethral cystolithotripsy because of patient anatomy. Percutaneous suprapubic cystolithotripsy was done through either a 30F or a 36F cystotomy tract. Fragmentation and removal was performed with a 26F rigid nephroscope and the pneumatic Swiss Lithoclast. Suprapubic and urethral catheters were placed postoperatively in all patients. RESULTS: Each patient was cleared of the stone burden with a single procedure, and there were no major complications. The mean duration of suprapubic catheterization was 2.6 (range 1-5) days. CONCLUSION: Percutaneous suprapubic cystolithotripsy is an effective and safe technique for treating large bladder calculi. It is minimally invasive, avoids urethral injury, and, in combination with the pneumatic Swiss Lithoclast, can be used to fragment and remove large and hard bladder calculi.     

An unusual presentation of a foreign body in the urinary bladder: A migrant intrauterine device.

A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.     

异位可控膀胱术后合并贮尿囊结石的内窥镜治疗

目的:探讨全膀胱切除异位可控膀胱术后合并贮尿囊结石的内窥镜治疗方法。方法:2003年3月～2011年5月期间对11例全膀胱切除异位可控膀胱术后合并贮尿囊结石的患者采用摄像监视系统、灌洗泵、不同内窥镜及碎石系统经输出道进入贮尿囊进行碎石及取石,其中3例阑尾输出道患者采用F8/9.8Wolf输尿管硬镜或输尿管软镜进入贮尿囊内行气压弹道碎石或钬激光碎石;4例回肠输出道患者采用F19.5Wolf尿道膀胱镜进入贮尿囊内行气压弹道碎石或钬激光碎石;4例回肠输出道患者采用F21Wolf肾镜进入贮尿囊内行EMS超声碎石。结果:11例患者经输出道将贮尿囊内结石全部取出,并发症出现少,对输出道的抗尿失禁作用影响少。结论:对全膀胱切除异位可控膀胱术后合并贮尿囊结石,可采用不同的碎石系统和不同的内窥镜经输出道进入贮尿囊内进行碎石,其并发症少,效果满意。     

耻骨上小切口膀胱切开取石与经尿道钬激光碎石取石治疗大膀胱结石的疗效比较

目的 观察对比耻骨上小切口膀胱切开取石与经尿道钬激光碎石取石治疗大膀胱结石的临床效果.方法 选取2010年7月至2015年2月于本院诊治的合并良性前列腺增生的大膀胱结石患者共87例进行研究,随机原则分为研究组(n =45例)和对照组(n=42例),对照组实施经尿道钬激光碎石取石,研究组行耻骨上小切口膀胱切开取石治疗,均同期行TURP.比较两组术中出血量、总手术时间、取石时间、低体温、输血例数、住院时间、术后疼痛情况、治疗费用、术后并发症.结果 两组的出血量、住院时间、尿道狭窄发生率相比较无明显差异(P＞0.05);两组碎石取石时间、总手术时间对比,研究组均短于对照组(P＜0.05);研究组术中低体温发生率、治疗费用、术后泌尿系感染、结石残留发生率均较对照组更低(P＜0.05).结论 对临床中大膀胱结石患者采取耻骨上小切口膀胱切开取石治疗,手术时间短,结石残留率低,术后并发症少,效果显著,值得推广.