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.     

微通道经皮膀胱取石术治疗小儿膀胱结石(附16例报告)

目的探讨微通道经皮膀胱取石术治疗小儿膀胱结石的可行性及临床疗效。方法2002年5月至2009年1月,采用微通道经皮膀胱取石术对16例小儿膀胱结石进行治疗。年龄1～7岁,结石直径9～27mm。插管全麻仰卧位,经尿道置入8F导尿管,注入生理盐水使膀胱充分充盈。于耻骨联合上1～2cm处用18G穿刺针穿刺膀胱,置入金属导丝。8F筋膜扩张器沿导丝依次扩张皮肤至膀胱至16F,留置16FPeel-away鞘。内窥镜经工作鞘入膀胱,用钬激光或气压弹道击碎结石,碎石沿皮肤膀胱通道冲出。术毕留置12F或14F膀胱造瘘管,未留置导尿管,膀胱造瘘管术后1周拔除。结果本组16例手术均成功,结石取净率100%。患儿无明显出血、肠管损伤等并发症发生,术后随访3～13个月,无排尿困难、无尿道狭窄发生、无结石复发。结论微通道经皮膀胱取石术治疗小儿膀胱结石具有创伤小、痛苦少、操作简便、结石取净率高等优点,可有效避免传统开放手术的较大创伤及经尿道手术导致的术后尿道狭窄的风险。     

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。     

经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石的临床观察

目的探讨经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石的临床疗效。方法回顾性分析采用经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石41例患者的临床资料。所有患者均经电切镜外鞘置入肾镜，采用瑞士第四代EMS气压弹道碎石机击碎膀胱结石后，用Ellick冲洗器冲出碎石。结果所有患者均一次性碎石成功，术中术后无膀胱穿孔、大出血、水中毒等并发症。结论经电切镜外鞘联合肾镜气压弹道碎石取石术是治疗膀胱结石的一种有效方法，安全、疗效确切。     

经电切镜外鞘输尿管镜下气压弹道碎石治疗膀胱结石

目的评价电切镜外鞘辅助输尿管镜气压弹道碎石取石术处理膀胱结石的应用价值,探讨该方法的手术技巧。方法回顾分析98例膀胱结石行输尿管镜碎石取石的患者临床资料,其中,52例采用电切镜外鞘辅助输尿管镜气压弹道碎石取石术（镜鞘辅助组）,46例直接采用输尿管镜气压弹道碎石取石术（传统碎石组）;两组术后均常规留置18F三腔导尿管;比较两组的手术时间、结石清除率及手术并发症情况。结果98例均全部成功碎石取石,无一例中转开放手术;镜鞘辅助组与传统碎石组的手术时间为（44．4±5．1）minVS（53．2±6．2）min（t=-7．71,P〈0．01）,传统碎石组术中2例发生膀胱穿孔,予留置尿管持续引流治愈;两组术后均得到3个月～1年随访,传统碎石组术后1例发生尿道狭窄,予定期尿扩治愈;两组超声随访复查均未见结石残留或复发。结论术中应用电切镜外鞘辅助输尿管镜气压弹道碎石取石能使术野保持清晰,减少输尿管镜反复进出损伤尿道,结合一定的弹道碎石技巧可明显缩短手术时间,疗效确切,在输尿管镜处理膀胱结石中有重要的临床应用价值。     

双通道法治疗膀胱结石的疗效观察

目的:探讨经皮膀胱通道联合经尿道双通道法治疗膀胱结石的疗效及安全性。方法:回顾性分析我院2010年9月~2014年9月应用双通道法治疗40例膀胱结石患者的临床资料:年龄68.2(50~88)岁,男38例,女2例,其中前列腺增生并膀胱结石30例,尿道狭窄并膀胱结石2例,神经源性膀胱并膀胱结石7例,上尿路结石排入膀胱后无法排出1例。结石数量1~7枚。结果:本组40例患者的一次性清石率为100%,手术时间34(30~40)min,出血16(10~20)ml,造瘘感染率1/40,尿道狭窄无明显膀胱出血、无水中毒、膀胱穿孔及结石残留等并发症。30例前列腺增生并膀胱结石患者碎石后同期行经尿道前列腺电切术。结论:双通道法碎石取石术安全、有效,更适合临床应用。     

经皮膀胱造瘘气压弹道碎石治疗膀胱结石

目的探讨经皮膀胱造瘘输尿管镜或F12.5李逊微创肾镜下气压弹道碎石治疗膀胱结石的疗效。方法2003年2月~2006年8月采用经皮膀胱造瘘Peel-away鞘作为手术通道输尿管镜或F12.5李逊微创肾镜下碎石治疗膀胱结石32例。结果碎石时间10~45min,平均25min,均成功取净结石;术中无膀胱出血、穿孔、破裂,无尿道损伤;术后无膀胱、尿道感染。22例术后随访6~20个月,平均15个月,未见结石复发。结论经皮膀胱造瘘输尿管镜或F12.5李逊微创肾镜下气压弹道碎石治疗膀胱结石操作简单、安全、有效。     

腹腔镜膀胱切开取石术与电切镜下钬激光碎石术治疗复杂膀胱结石的疗效对比

目的 比较腹腔镜膀胱切开取石术与电切镜下钬激光碎石术治疗复杂膀胱结石的临床疗效。方法 选取本院2014年1月至2017年3月期间收治的复杂膀胱结石患者61例，随机分为研究组（29例）和对照组（32例）。研究组施行腹腔镜膀胱切开取石术，对照组施行电切镜下钬激光碎石术，比较两组的手术时间、术后留置尿管时间、住院时间、结石清除率及术后并发症发生率。结果 两组在住院时间、留置尿管时间比较差异无统计学意义（P>0.05）；研究组的手术时间短于对照组（P<0.05），结石清除率高于对照组（P<0.05），而研究组的泌尿系感染、尿道狭窄等并发症的发生率均低于对照组（P<0.05）。结论 腹腔镜膀胱切开取石术治疗多发、较大的膀胱结石效果更明显，具有手术时间短、结石清除率高、并发症少等诸多优点，值得临床广泛应用。     

经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石

目的探讨经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石的疗效。方法回顾性分析36例膀胱结石患者,其中单纯膀胱结石11例,合并前列腺增生17例,膀胱颈纤维化2例,尿道外口息肉1例,膀胱感染4例,经尿道前列腺电切术后1例,采用经电切镜外鞘置入输尿管镜下钬激光碎石。结果 36例均一次性击碎清除结石,无膀胱穿孔、大出血、尿道狭窄等并发症。结论经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石,具有创伤小、操作简单、手术时间短、并发症少等优点,是一种安全、有效的方法 。     

BPH并发膀胱结石的电切镜处理

目的:总结电切镜处理BPH并发膀胱结石的经验。方法:采用经尿道前列腺电切术(TURP)加电切镜夹取石术治疗36例BPH并发膀胱结石患者,术后观察其治疗效果。结果:术中无膀胱穿孔,术后无尿道狭窄,所有患者均一次性治疗成功。结论:采用TURP加电切镜夹取石术同期治疗BPH并发膀胱结石(结石直径〈1.2cm)是安全、高效的。     

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.     

腔内钬激光联合等离子治疗尿道狭窄的临床分析（附128例分析）

目的：探讨联合使用输尿管镜腔内钬激光及等离子双极电切治疗尿道狭窄的临床疗效及安全性。方法：对128例尿道狭窄患者（其中合并膀胱结石88例）采用输尿管镜行钬激光尿道狭窄内切开联合等离子双极电切,并在等离子电切镜鞘下使用钬激光碎石治疗,术后查B超、X线片及最大尿流率（Qmax）观察疗效。结果：128例患者均一次手术成功,无结石残留,手术时间15～92min,平均42min,留置尿管4～6周,拔除尿管后排尿通畅并定期尿道扩张。术后3个月Qmax较术前明显改善。结论：采用腔内钬激光联合等离子双极电切治疗尿道狭窄具有创伤小、并发症少优点,并能同时治疗膀胱结石,是安全有效的治疗方法。     

电切镜下同期治疗BPH并发膀胱结石疗效观察

目的：探讨BPH并发膀胱结石更为有效的治疗方法.方法：采用TURP联合电切镜下钬激光碎石术同期治疗BPH并膀胱结石患者23例,即通过电切镜电切攀通道置人经过裁剪的输尿管导管及钬激光光导光纤行膀胱结石钬激光碎石,冉行TURP.结果：23例均一次性手术成功,取石率100%,手术时间30～80 min,平均56 min,其中碎石时间3～20 min,平均9 min 术中无膀胱穿孔、膀胱出血、TURS 术后留置导尿3～5天,术后住院时间4～9天,平均5.6天 术后随访3～18个月.无结石复发,无尿道狭窄.结论：采用TURP加电切镜下钬激光碎石术治疗BPH并膀胱结石具有手术时间短、创伤小及安全等优势,能够治疗膀胱较大结石、多发结石,对治疗伴有膀胱出血患者更显优势.     

组配碎石吸石系统处理尿路结石

目的 探讨利用原有器械组配碎石吸石系统,处理膀胱结石、肾结石等尿路结石的方法.方法 2010年12月至2011年8月收治膀胱结石患者4例.均为男性.年龄42～79岁,平均63岁.两例合并尿道狭窄,其中一例患者曾有骨盆骨折、尿道断裂史,尿道狭窄几近闭锁,留置有膀胱造瘘管.另两例为前列腺增生合并膀胱结石.通过医院原有设备,...     

经电切镜外鞘气压弹道治疗膀胱结石20例报告

目的探讨气压弹道治疗膀胱结石的新方法. 方法经电切镜外鞘置入输尿管镜或肾镜,气压弹道将膀胱结石击碎取出. 结果 20例均顺利一次性将结石取尽.术中、术后无大出血、膀胱穿孔和水中毒等并发症.20例术后随访2～18个月,平均4.6月,B超未见结石复发,无排尿不畅等尿道狭窄症状. 结论电切镜外鞘气压弹道碎石是处理膀胱结石的有效方法.     

Urethral obstruction from dislodged bladder Diverticulum stones: a case report

Background

Secondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature.

Case presentation

A 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP) and was lost to follow up. He re-presented with retained urethral catheter of 4months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury.

Conclusions

Urethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.     

Management of pediatric urolithiasis in Pakistan: experience with 1,440 children

PURPOSE: We evaluated the efficacy and safety of different modalities for pediatric urolithiasis in a developing country in 2 eras, namely before and after the advent of minimally invasive surgery. MATERIALS AND METHODS: We retrospectively reviewed the records of 1,440 children younger than 14 years treated with various modalities during a 14-year period. From 1987 to 1995, 486 and 50 patients were treated with open surgery, and extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) and minimally invasive methods, respectively. Between 1996 and 2000, 518 and 386 children were treated with surgery and minimally invasive methods, respectively. RESULTS: Of the 1,440 children 795 (55.2%) had renal, 198 (13.8%) had ureteral and 447 (31%) had bladder calculi. Of the renal stones 556 (70%), 177 (22%) and 62 (7.8%) were treated with open surgery, ESWL and percutaneous nephrolithotomy, respectively. Of the ureteral calculi 85 (43%), 37 (18.6%) and 76 (38%) were managed by ESWL, ureterorenoscopy and open surgery, respectively. Of the bladder calculi 307 (68%), 77 (17.2%) and 63 (14%) were treated with open vesicolithotomy, transurethral pneumatic cystolithotripsy and ESWL, respectively. The renal stone clearance rate was 98% after open surgery, 84% after ESWL and 68% after percutaneous nephrolithotomy monotherapy at 3 months of followup. Similarly the ureteral stone-free rate was 54% after ESWL and 86.9% after ureterorenoscopy. Of the patients with bladder calculi 48% and 93% become stone-free after ESWL and transurethral pneumatic cystolithotripsy, respectively. CONCLUSIONS: The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.     

Percutaneous versus transurethral cystolithotripsy and TURP for large prostates and large vesical calculi: Refinement of technique and updated data

Background and purpose: We compare two modalities of treatment; transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL), for large vesical calculi in patients who underwent simultaneous transurethral resection of prostate (TURP), and present refinements of the technique of PCCL. Patients and methods: Between July 1999 and June 2003, 54 patients were subjected to either TUCL (n = 19) or PCCL (n = 35) along with simultaneous TURP. Inclusion criteria were prostate volume > 50 ml, aggregate stone size > 3 cm with each individual stone > 1 cm, In the TUCL group, calculi were treated with 26F nephroscope, pneumatic lithotripsy and fragment extraction. This was followed by TURP with 26F continuous-flow resectoscope. In the PCCL group, calculi were removed through a suprapubic 30F Amplatz sheath followed by standard TURP with the suprapubic sheath in situ to provide continuous drainage. A 20F two-way Foley catheter was inserted suprapubically and urethrally in cases of PCCL and a 22–24F three-way catheter urethrally after TUCL. Results: The two groups were comparable in age. The mean prostate size as well as aggregate stone size was significantly larger in PCCL group. The operating time for stone removal was significantly less in the PCCL group while time required for TURP was statistically similar in two groups. In the TUCL arm three patients had residual stones requiring repeat TUCL, and one developed a urethral stricture.Conclusions: Combined TURP and PCCL is safe, more effective and a much faster alternative to combined TURP and TUCL in patients with large bladder calculi and large prostates.