膀胱结石232例分析

1992年 10月至 2 0 0 2年 10月我们收治膀胱结石 2 32例 ,现报告如下。材料与方法　本组 2 32例。男 2 14例 ,女 18例。年龄 12～ 76岁 ,平均 4 6岁。其中 12岁和 17岁各 1例 ,为男性 ,均采用膀胱切开取石术。异物、缝线及T形节育环导致者 18例采用膀胱切开取石术。双J管导致者 4例 ,1例合并上尿路结石 ,先行肾盂内结石的体外冲击波碎石术 (ESWL) ,配合输尿管镜及气压弹道碎石术击碎输尿管内附着于双J管的结石 ,松解双J管后将其拔除 ,再次置放双J管 ,多次配合ESWL逐步清除残余结石 ;余 3例仅有膀胱结石 ,经尿道机械碎石治疗。长期留置…     

微创腔内弹道碎石治疗尿石症

1999年 3月～ 2 0 0 0年 1 2月 ,我院应用日产Olympus腔内电子动能弹道碎石器并配合日产Olympus输尿管镜及膀胱镜治疗输尿管中下段结石及石街 63例 ,膀胱结石 4例 ,效果满意 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 67例 ,男 38例 ,女 2 9例 ,年龄 33～ 60岁 ,平均 43.5岁。输尿管中下段结石 35例 ,输尿管中下段 ESWL术后石街 2 8例 ,膀胱结石 4例。结石横径 5～ 30 mm,长径 7～ 35mm。1 .2 　 治疗方法采用持续硬膜外腔麻醉 ,患者取截石位。在注水情况下经尿道插入 Olympus F87°输尿管硬镜 ,从输尿管镜工作道插入直径为 0 .6…     

微创治疗膀胱结石的三种方法比较

我院从1989年1月至2010年12月相继采用液电碎石、ESWL、气压弹道碎石三种微创方法治疗膀胱结石176例.现将这三种方法进行比较并报告如下. 临床资料 1.一般资料:本组患者176例,男157例,女19例;年龄25～84岁.大都具有尿频、尿急、尿痛,部分有尿流中断、血尿表现,均经B超及X线检查证实为膀胱结石.后尿道结石推入膀胱13例.1例为膀胱癌行全膀胱切除正位回肠膀胱术后2年出现急性尿潴留发现膀胱结石.部分患者合并有前列腺增生、尿潴留、冠心病、尿路感染等.结石大小0.5cm×0.5cm～4cm×3cm不等.膀胱多发结石24例,合并上尿路结石21例.     

气压弹道碎石联合ESWL治疗输尿管中下段结石

目的：探讨气压弹道碎石联合体外冲击波碎石术（ESWL）治疗输尿管中下段结石的临床疗效。方法：采用气压弹道碎石联合ESWL治疗输尿管中下段结石188例。结果：188例中,185例碎石成功,2例碎石失败,1例输尿管穿孔。结论：气压弹道碎石联合ESWL治疗输尿管中下段结石有高效、安全、并发症少、适应证广的优点。     

上尿路结石非手术治疗分析

对ESWL及输尿管镜下气压弹道碎石疗效分析认为两种方法均安全、效果确切、损伤小，若二结合应用，疗效更佳。92．8％的上尿路结石可通过ESWL治愈，78．7％的输尿管结石可通过输尿管镜下气压弹道碎石治愈。肾结石越大，碎石率及排石率越低，直径大于2cm、质地坚硬的草酸钙、磷酸钙、     

心脏人工瓣膜置换术后尿石症的碎石治疗(附15例报告)

我院 1 990年 4月～ 2 0 0 0年 1月对 1 5例心脏人工瓣膜置换术后尿石症患者采用碎石治疗 ,疗效满意 ,现报告如下。1　临床资料本组 1 5例 ,男 6例 ,女 9例 ,年龄 44～ 61岁。心功能 ～ 级。 7例于外院行 ESWL治疗后以大量肉眼血尿就诊 ,血尿持续时间 2～ 2 1 d,其中 4例结石残留 (肾结石 1例、上段输尿管结石 1例、中下段输尿管结石 2例 )。 8例以上尿路结石就诊 ,其中肾结石 3例 ,上段输尿管结石 1例 ,中下段输尿管结石 4例。2　治疗与结果对以血尿就诊的 7例患者 ,首先肌肉注射维生素 K12 0 mg,约 6h(或静脉注射 30 min)后 ,凝血酶原…     

钬激光、ESWL、气压弹道碎石术治疗输尿管结石的疗效比较

目的：比较钬激光碎石术（LL）、体外冲击波碎石术（ESWL）、气压弹道碎石术（PL）治疗输尿管结石的疗效和安全性。方法：总结ESWL、PL、LL治疗输尿管结石的临床资料,其中ESWL150例、PL66例、LL50例。结果：LL单次手术碎石率为96.0%,PL为60.6%,ESWL为50.7%;LL平均结石排净时间为22d,PL为40d,ESWL为90d;LL组 无明显并发症,PL组有2例发生穿孔,ESWL组有3例发生石街。结论：LL在效率及安全性方面明显优于PL与ESWL。LL是治疗输尿管结石的一种较新、高效、安全的方法。     

输尿管镜气压弹道碎石治疗肾结石23例

目的探讨输尿管镜气压弹道碎石治疗肾结石的可行性。方法回顾分析2001年1月～2004年3月23例肾上盏结石和肾盂结石采用输尿管镜经下尿路气压弹道碎石的临床资料。结果23例均获成功,无并发症。手术时间25～60min,平均45min。6例肾盂结石术后2周残留长径>0.5cm结石,行ESWL1～2次,术后3个月结石全部排净。23例术后3个月复查腹部平片和静脉肾盂造影,结石排净,12例轻度肾积水消失,11例中、重度积水改善。结论选择合适病例采用输尿管镜经下尿路实施气压弹道碎石可以治疗肾上盏结石和肾盂结石。     

尿石症性肾衰患者的肾移植2例报告

报告２例尿石症性肾功能衰竭患者接受肾移植的临床情况，结果２例肾移植获成功；术后随访：１例２年７个月死于肝硬化、腹水及消化道大出血，１例术后５个月失去随访，认为此类患者肾移植成功的关键有３点：（１）认真做好术前检查，寻找病因；（２）术中注意手术方法与技巧的运用；（３）术后加强移植肾Ｂ超及Ｘ线的随访复查。     

输尿管镜直视下气压弹道碎石治疗小儿下尿路结石9例报告

我院自2002-2004年应用输尿管镜直视下气压弹道碎石术治疗小儿下尿路结石患者9例，效果满意，现报告如下。     

Preliminary experience with the pulsed dye laser for treatment of urolithiasis

We report our initial experience using the pulsed dye laser in 26 patients with urolithiasis. The patients ranged in age from 27 to 82 years; 11 patients were female and 15 were male. Of the 26 patients, 4 stones were in the kidney, 21 were in the ureter, and one was in the bladder. Surgical time ranged from 32 to 130 minutes. All patients were treated under spinal or general anesthesia. The size of ureteral stones ranged from 0.2 to 1.5 cm, and the renal stones 3.0 to 4.0 cm. Chemical analysis of the stones was not available on all patients, but when available, chemical analysis revealed the stones to be calcium monohydrate, calcium dihydrate, or struvite. The use of the Candela miniscope in 11 patients permitted access without ureteral dilation. In 19 patients, ureteral stents were placed. One patient suffered a ureteral perforation. Success was defined as adequate disintegration of the stone for passage of the fragments without the necessity of a secondary procedure. Using this criterion, 22 of 26 patients were successfully treated for an overall success rate of 85%.     

输尿管结石气压弹道碎石术与体外冲击波碎石术疗效比较

目的：比较输尿管结石气压弹道碎石术与体外冲击波碎石术的疗效。方法：回顾分析130例气压弹碎石术与1600例体外冲击波碎石术的的碎石率、结石排净率、平均结石排净时间及并发症发生率。结果：气压弹道碎石术碎石率、结石排净率均大于体外冲击波碎石术，平均结石排出时间小于体外冲击波碎石术，并发症发生率两组问无明显差异。结论：输尿管结石行气压弹道碎石术优于体外冲击波碎石术。     

65例输尿管阴性结石的治疗

目的 总结治疗输尿管阴性结石的方法及疗效。方法采用体外冲击波碎石（ESWL）、气压弹道碎石（PL）治疗输尿管阴性结石65例。结果65例患者中，40例采用PL，结石排尽36例，2例残留，联合ESWL，结石排出，2例改手术取石；25例采用ESWL辅助输尿管插管，1次碎石成功18例，2次碎石成功4例，3例改PL治疗。结论PL及ESWL辅助输尿管插管，是治疗输尿管阴性结石有效、安全的方法。     

Ammonium acid urate urolithiasis in Japan

AIM: Ammonium acid urate (AAU) calculi are a rare urolithiasis in developed countries but are endemic in developing countries. We assessed the features of AAU urolithiasis in Japanese patients. METHODS: We reviewed hospital charts of patients with urolithiasis who were treated with extracorporeal shock wave lithotripsy and endourological procedures at Sagamidai Hospital (Kanagawa, Japan) from January 1992 to December 2001. On the basis of the results of stone analysis with an infrared spectrophotometer, AAU stones were found. RESULTS: Of 8664 urolithiasis that we reviewed, 33 calculi (0.38%) from 29 patients contained AAU crystals. From crystallographic findings, we defined two types of AAU-containing stones: pure and mixed AAU urolithiasis. Pure AAU urolithiasis were seen in 13 stones from 10 patients and mixed AAU in 20 stones from 19 patients. We found significant differences between the groups: the pure AAU group predominantly consisted of young, thin women and the mixed group consisted of middle-aged men. Laboratory findings showed trends of low levels of serum protein, potassium, and urine pH in the pure AAU group. CONCLUSIONS: Because each type of AAU urolithiasis is associated with different patient characteristics and pathophysiological features, it is important to understand the type of AAU urolithiasis in patients with calculi.     

The management of urolithiasis

The incidence and prevalence of urolithiasis is on the rise; though inevitably the increasing availability of cross-sectional imaging has some contribution to this rise in diagnoses, it cannot take all the blame. Urolithiasis is now more commonly being recognized as a symptom of a more systemic disease which has a constellation of presenting signs and complaints. The authors aim to outline the precipitating causes of urolithiasis, along with a comprehensive discussion of the current operative trends available to the practising endourologist. Despite largely being tailored to trainees within Core Training, in parts the discussion will head beyond that what is expected during basic surgical training and move into topics of debate within higher specialist training.     

移植肾尿路结石46例诊治体会

目的探讨肾移植术后尿路结石的诊断和治疗,提高长期存活率。方法回顾性分析1980年1月至2011年6月46例移植肾结石患者的临床资料。结果 35例为肉眼血尿,10例为体检时B超发现,1例为急性无尿发病,均无肾绞痛。移植肾结石24例,移植输尿管结石22例,结石大小0.7～2.0 cm,结石发病时间为术后3.5（0.4～15）年。42例行体外冲击波碎石（ES-WL）,其中3例无效行输尿管镜下钬激光碎石术和1例行经皮肾镜取石术（PCNL）,4例尿酸结石给予枸橼酸氢钾钠（友来特）药物治疗。随访3个月：42例ESWL中,结石排净36例（85.72%）,结石残留2例（4.76%）,4例（9.52%）无效改用腔镜治疗后结石排出;4例尿酸结石口服枸橼酸氢钾钠结石大部分排出。结论移植肾结石缺乏典型肾绞痛表现,体外冲击波碎石术是治疗移植肾结石安全、有效的主要方法。     

Management of urolithiasis

Urolithiasis is a common urological condition. Its incidence is increasing. It is one of the commonest urological emergencies, and has important, occasionally life-threatening, differential diagnoses. Treatment of an infected obstructed kidney is a urological emergency, and supportive treatment and swift drainage are paramount. Decision making for the treatment of stones depends upon stone size, site, patient and kidney factors, with active surveillance, ESWL, ureteroscopy and laser stone fragmentation and PCNL all possible options. Metabolic investigation of high-risk stone formers and advice regarding the prevention of stone formation are important.     

The management of urolithiasis

The incidence and prevalence of urolithiasis is on the rise; though inevitably the increasing availability of cross-sectional imaging has some contribution to this rise in diagnoses, it cannot take all the blame. Urolithiasis is now more commonly being recognized as a symptom of a more systemic disease which has a constellation of presenting signs and complaints. The authors aim to outline the precipitating causes of urolithiasis, along with a comprehensive discussion of the current operative trends available to the practising endourologist. Despite largely being tailored to trainees within Core Training, in parts the discussion will head beyond that what is expected during basic surgical training and move into topics of debate within higher specialist training.     

Extracorporeal shock wave lithotripsy with a transportable electrohydraulic lithotripter: experience with >300 patients

OBJECTIVE: To review a multicentre experience of using a transportable lithotripter (STS-T, Medstone, Inc, Aliso Viejo, CA. USA) for treating patients with urolithiasis in all parts of the urinary tract. PATIENTS AND METHODS: In all, 326 patients with a total of 370 stones were treated as outpatients with the STS-T lithotripter. All patients received a single shock wave lithotripsy treatment and were followed after 4-6 weeks in the outpatient clinic, the primary endpoint being to determine the efficacy (as defined by the stone-free rate). Secondary objectives included establishing a database of patient demographic information, stone characteristics, stone location, procedural endpoints, and complication rates. RESULTS: In all there were 370 procedures, with a mean of 2394 shocks administered at an energy level of 24 kV. The mean treatment time was 51 min, excluding anaesthesia-induction time. The mean stone aggregate size was 8.2 mm; 62% of the stones were in the kidney while 38% were in various locations in the ureter. Of the treated stones, 90% had definite or probable evidence of fragmentation. The overall stone-free rate after one treatment with the STS-T was 52.8%. Of patients with residual fragments, most (61%) had fragments of <4 mm in aggregate diameter. The overall complication rate was 3.8%, the most common complication being postoperative pain. CONCLUSION: The Medstone STS-T lithotripter was an effective device for treating urolithiasis in all parts of the urinary tract. This system had a high margin of safety, as shown by the low complication rate. With no apparent sacrifice of efficacy compared to first-generation or fixed (not transportable) second-generation devices, the Medstone STS-T represents an important advance in the development of a truly transportable lithotripter.     

Pediatric urolithiasis: review of research and current management

The treatment of urolithiasis in children has changed dramatically in recent years. With the proven safety and efficacy of extracorporeal shock wave lithotripsy (ESWL), percutaneous lithotripsy and ureteroscopy in adults, these modalities are now in the forefront of the treatment of pediatric urinary stones. Our research in the juvenile non-human primate with ESWL indicates that renal damage in most cases is neither significant or persistent. In addition, technological advances in instrumentation have cleared the way for the use of percutaneous lithotripsy and ureteroscopy in most pediatric patients. Today, open surgical procedures for stone disease in children should be a last resort.