输尿管镜下气压弹道碎石治疗输尿管中下段结石伴息肉(附56例报告)

目的探讨输尿管镜下气压弹道碎石治疗输尿管中下段结石伴息肉的方法. 方法回顾分析56例输尿管镜下气压弹道碎石治疗输尿管中下段结石伴息肉的临床资料. 结果 56例均取得成功,无并发症发生. 结论输尿管镜下气压弹道碎石同时治疗输尿管中下段结石和息肉可行.     

输尿管镜、肾镜治疗输尿管结石(附226例报告)

目的探讨应用输尿管镜、肾镜治疗输尿管结石的疗效。方法应用输尿管镜、肾镜配合瑞士产EMS三代超声气压弹道碎石机治疗226例输尿管结石。上段结石58例采用经皮肾镜超声气压弹道碎石机碎石,其余168例中下段结石采用输尿管镜逆行气压弹道碎石。结果一次碎石成功211例,结石排净时间1周-3个月。术中无输尿管穿孔和撕脱。15例结石上冲至肾盂,放置双J管后行ESWL治疗,3个月结石排净。结论输尿管镜、肾镜配合瑞士产EMS三代超声气压弹道碎石机治疗输尿管结石高效,微创,安全可靠。     

输尿管镜下气压弹道碎石术治疗儿童输尿管结石

目的 探讨输尿管镜下气压弹道碎石术治疗儿童输尿管结石的临床疗效。方法 应用输尿管镜气压弹道碎石术治疗儿童输尿管结石16例。其中上段结石2例。中段5例，下段9例。结果 碎石成功14例，成功率为87．5％，1例术中结石滑入肾盂，行体外冲击波碎石后排净。1例进镜困难，改开放性手术。随访1-12个月，结石均排净，无尿道狭窄、尿失禁、尿液返流及结石复发。结论 输尿管镜下气压弹道碎石术治疗儿童输尿管结石，安全有效，成功率高，值得临床推广应用。     

输尿管镜气压弹道碎石术治疗输尿管结石186例报告

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的疗效。方法对186例输尿管结石行输尿管镜气压弹道碎石术治疗。结果36例输尿管上段结石气压弹道碎石成功率80．6％（29／36）；55例输尿管中段结石气压弹道碎石成功率92．7％（51／55）；95例输尿管下段结石气压弹道碎石成功率100％（95／95）。术中发生输尿管损伤5例（2．7％）。术后4周复查结石清除率94．1％（175／186）。结论经尿道输尿管镜气压弹道碎石术是治疗输尿管结石的一种安全、有效的方法。     

输尿管镜气压弹道碎石治疗输尿管结石110例

目的总结输尿管镜气压弹道碎石治疗输尿管结石的临床效果。方法采用F8/9.8 Wolf硬性输尿管镜、JUN—AIR气压弹道碎石机治疗110例输尿管结石。结果输尿管镜直视下一次碎石成功105例，成功率95．5％（105／110），1～6周内结石全部排净。2例因置镜失败改开放手术，3例输尿管上段结石上移至肾脏行ESWL2例，口服排石药物治疗1例。术后泌尿系感染5例，轻度肉眼血尿1～3d。结论输尿管镜气压弹道碎石是治疗输尿管中、下段结石的有效方法之一，具有碎石率高、安全、并发症少、操作简单的优点。     

输尿管硬镜气压弹道碎石治疗输尿管结石疗效分析

目的探讨输尿管硬镜气压弹道碎石治疗输尿管结石的疗效。方法采用输尿管硬镜气压弹道碎石治疗输尿管结石共185例200侧。结石位于输尿管上段22侧，中段37侧，下段141侧。结果输尿管上段、中段、下段结石碎石成功率分别为45．4％、81．1％、97．2％。手术并发症发生率为1．5％。结论输尿管硬镜气压弹道碎石治疗输尿管中下段结石安全有效，损伤小，可作为治疗输尿管中下段结石的首选方法。     

输尿管镜气压弹道碎石治疗输尿管上段结石临床体会

目的探讨输尿管镜气压弹道碎石术治疗输尿管上段结石疗效。方法对60例应用输尿管镜下气压弹道碎石术治疗输尿管上段结石回顾性分析。结果 46例患者术中完全碎石,12例患者术中结石移入肾盂,均留置双J管后行体外冲击波碎石(ESWL)治疗。2例输尿管扭曲或狭窄致进镜困难,无法窥见结石,其中1例转开放手术,1例置双J管后ESWL治疗。结论输尿管上段结石采用输尿管镜气压弹道碎石以及术后结合ESWL疗效肯定,但术中操作者的熟练操作、冲洗速度的调整、术前合适病例的选择是手术成功的关键。     

输尿管镜气压弹道碎石术治疗输尿管结石68例

目的：探讨输尿管镜气压弹道碎石术治疗输尿管结石的效果。方法：对68例输尿管结石患者行输尿管镜气压弹道碎石治疗,观察对各段输尿管碎石的成功率。结果：输尿管镜一次碎石率91.2%,其中上段66.6%,中段80%,下段100%。结论：输尿管镜气压弹道碎石术高效、安全、损伤小,可作为治疗输尿管中下段结石的首选方法。     

输尿管镜气压弹道治疗输尿管结石260例临床分析

目的 探讨输尿管镜气压弹道碎石术治疗输尿管结石的疗效.方法 回顾性分析2006年10月～2012年10月260例输尿管结石采用输尿管镜联合气压弹道碎石术治疗的临床疗效.结果 244例碎石成功或取出,成功率93.8％.其中上段结石成功率75.9％(41/54),中下段为98.5％(203/206).25例进镜困难,采用镜体旋转、变换角度,经扩张以及调整体位后入镜成功.13例结石上移入肾盂,置入双J管后行体外冲击波碎石术.3例因严重输尿管狭窄转开放手术.结论 输尿管镜联合气压弹道碎石治疗输尿管结石手术效果好,尤其是中下段结石,对于输尿管镜进镜困难,需要一定技术要求,必要时改开放手术.     

输尿管结石的输尿管镜气压弹道碎石术治疗

目的探讨提高治疗输尿管结石疗效的方法。方法对146例(153侧)输尿管结石行输尿管镜气压弹道碎石术治疗。结果输尿管上段结石32侧气压弹道碎石成功率为53.1%;输尿管中段结石15侧气压弹道碎石成功率为66.7%;输尿管下段结石106侧气压弹道碎石成功率为95.3%。治疗输尿管结石总成功率为83.7%(128/153),手术并发症为2.6%(4/153)。结论经尿道输尿管镜气压弹道碎石术是治疗输尿管结石的一种安全、有效的方法。     

经尿道输尿管镜联合体外震波碎石治疗输尿管结石256报告

目的探讨输尿管镜联合体外震波碎石（extracorporeal shock wave lithotripsy，ESWL）治疗输尿管结石的价值。方法2005年10月-2007年6月采用输尿管镜联合ESWL治疗输尿管结石256例，中段（56例）及下段（170例）结石用输尿管镜取石，上段（30例）结石用ESWL碎石，输尿管镜取石失败或结石残留联合ESWL治疗。结果输尿管下段结石一期结石清除率98．2％（167／170），中段结石一期结石清除率89．2％（50／56），上段结石一期结石清除率73．3％（22／30）。输尿管穿孔3例，输尿管黏膜撕脱1例，结石远端输尿管扭曲进镜致使尿管穿孔改切开取石1例，输尿管镜取石失败或结石残留联合ESWL治疗二期结石清除率91．7％（11／12）。结论输尿管镜治疗输尿管下段及中段结石成功率高，输尿管镜取石失败或结石残留联合ESWL可提高二期结石清除率。     

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.     

Management of ureteral stones in pediatric patients.

PURPOSE: We report our 5-year experience in the management of ureteral stones in pediatric patients using shockwave lithotripsy (SWL) in combination with ureteroscopy. PATIENTS AND METHODS: A total of 25 children (age range 12 months-14 years; mean 8.7 years) underwent SWL for ureteral lithiasis. Stones were located in the upper ureter in 6 children (24%), the middle ureter in 8 (32%), and the lower ureter in 11 (44%). Their size ranged from 5 to 14 mm (mean 10.9 mm). The children who failed SWL underwent ureteroscopic treatment. RESULTS: In the SWL-only group, the overall stone clearance rate at 3 months was 84% (21 of 25 children). Four children (16%) who failed SWL underwent successful ureteroscopic treatment. Complications were infrequent and generally minor in both groups. CONCLUSIONS: Shockwave lithotripsy is a safe and efficient treatment modality for ureteral stones in pediatric patients. In expert hands, ureteroscopy can be successfully applied in case of SWL failure.     

Retrograde ureterorenoscopy in the management of ureteral calculi

Endourologic techniques have revolutionized the line of treatment of ureteral stones. The scope of open ureterolithotomy has been narrowed and the contraindications for endoscopic manipulations of ureteric stones became limited. Using the rigid ureterorenoscope (URS) after endoscopic dilatation of the intramural ureter, we have manipulated 45 ureteral stones located at different levels, 33 in the lower ureter (distal ureter), 7 in the middle third and 5 in the upper third (proximal ureter). Successful manipulations occurred in 32 stones (in 21 by retrieval and in 11 by disintegration using ultrasonic lithotripsy). Failures were due to upward dislodgement of the stone in 5 cases to grasp or disintegrate the stone in 2, perforation of the ureter in 2, bleeding from the ureteral wall in 2 cases, to reintroduce guidewire in the ureter and to non-passable stricture below the stone in 1 case each. Delayed complications occurred in 4 patients. Two patients developed ureteral stricture, one suffered vesicoureteral reflux and one ultimately had urethral stricture.     

Comparison of transurethral ureteroscopy and extracorporeal shock wave lithotripsy for treatment of ureteral calculi

Ureteral calculi were treated by transurethral uretereoscopy and extracorporeal shock wave lithotripsy (ESWL), and the results were compared. Rigid transurethral ureteroscopy was performed in 50 patients, and 10 of 22 stones located in the upper ureter and 25 of 29 stones located in the lower ureter were successfully extracted. On the other hand, we treated 88 patients with upper ureteral stones by ESWL and achieved a success rate of 89.8%. We therefore conclude that for upper ureteral stones, ESWL is the more effective treatment and, for lower ureteral stones, transurethral ureteroscopy.     

输尿管肾镜气压弹道碎石术治疗输尿管膀胱尿道结石(附152例报告)

目的：探讨输尿管肾镜气压弹道碎石术治疗输尿管、膀胱、尿道结石的疗效与安全性。方法：回顾性分析经尿道输尿管肾镜气压弹道碎石术治疗的152例尿道、膀胱、输尿管结石患者的临床资料。结果：4例男性尿道结石和20例膀胱结石均碎石成功，输尿管中下段结石109例，107例成功，2例输尿管口狭窄改用ESWL碎石成功；输尿管上段结石19例，12例原位碎石成功，2例输尿管镜插至输尿管中段上行受阻插管改ESWL碎石成功，5例部分碎石冲入或推入肾内置引流管后行ESWL碎石成功。结论：输尿管肾镜气压弹道碎石术治疗输尿管及其以下尿路结石，具有安全可靠、损伤小、术后恢复快等优点，是微创治疗的有效方法之一。对于输尿管上段结石，将该手术配合ESWL也能取得满意疗效。     

Safety and outcome of rigid ureteroscopy for management of ureteral calculi in children

PURPOSE: To present our experience with ureteroscopy for the treatment of pediatric ureteral calculi. PATIENTS AND METHODS: The records of 32 children with an average age of 8.7 years (range 2-15 years) treated with rigid ureteroscopy between June 1994 and July 2003 were reviewed. In 33 ureteral units, 8F rigid ureteroscopy was carried out 35 times to treat stone disease. Stones were located in the upper ureter in 2 cases, the middle ureter in 2 cases, and the lower ureter in 29 cases. Stone size ranged from 4 to 15 mm (mean 7 mm). Dilatation of the ureteral orifice was necessary in 10 procedures. RESULTS: The management of stone in 29 children (90.7%) was straightforward, and a single procedure was sufficient to clear the ureters. In 2 children (6.2%), repeat ureteroscopy was undertaken to render the ureters stone free, and in 1 child (3.1%), it was not possible to remove the stone. Stones were fragmented with pneumatic lithotripsy in 2 cases and with the holmium laser in 9; in the remaining 22 cases, the stones were removed without fragmentation. Intraoperative complications occurred in 3 children (9.3%) and consisted of extravasation (1 patient) and stone migration (2 patients). The early postoperative complications were hematuria in one patient and renal colic in another. Of the patients, 28 were followed 3 to 48 months. No stricture was detected at the site of stone impaction in any patient. CONCLUSION: In the hands of an experienced surgeon, ureteroscopy can be a safe and efficient treatment for ureteral stones in children.     

Rigid ureteroscopy for the treatment of ureteral calculi in children

PURPOSE: We assess the safety and efficacy of rigid ureteroscopy for the treatment of pediatric ureterolithiasis. MATERIALS AND METHODS: The records of 33 children with an average age of 7.4 years (range 9 months to 15 years) treated with rigid ureteroscopy between May 1995 and July 2003 were reviewed. In 35 ureteral units use of a rigid 6.9 to 10Fr ureteroscope was planned for treating stones at various levels of the ureter. Stones were located in the upper ureter in 6 cases, middle ureter in 3 and lower ureter in 26. Dilatation of the ureteral orifice was necessary in 11 cases. RESULTS: Stone size varied from 3 to 10 mm (mean 5.3). In 33 patients (94%) all stone fragments were removed successfully. Stones were fragmented with pneumatic lithotripsy in 20 cases and removed by forceps without fragmentation in 13. In 1 child an upper ureteral stone migrated up to the kidney during ureteroscopy but following extracorporeal shock lithotripsy therapy she was rendered stone-free. In another child it was not possible to remove the stone. In a 9-month-old female patient with bilateral stones it was not possible to enter the left ureter because of a tight orifice resistant to balloon dilation. At the end of the procedure a 3 or 4Fr ureteral or a 4.8Fr Double-J (Medical Engineering Corp., New York, New York) stent was left in place for 3 days to 3 weeks in 12 cases. There were no cases of ureteral perforation. Of the patients 31 were followed for 1 to 36 months. No incidence of vesicoureteral reflux was detected in 9 who underwent postoperative cystography. CONCLUSIONS: After becoming experienced and meticulously working with finer instruments in adults, rigid ureteroscopy can be a safe and efficient treatment for ureteral stones in every location in children.     

Ureteroscopic management of ureteral calculi in children

PURPOSE: To evaluate the efficacy and safety of rigid ureteroscopy for the treatment ureteral calculi in children. PATIENTS AND METHODS: Between January 2002 and January 2006, 16 boys and 25 girls with an average age of 9.5 years (range 3-15 years) were treated with a 95F rigid ureteroscope for stones 4 to 10 mm (mean 5.6 mm) in 46 renoureteral units (RUUs), and the results were evaluated. The stones were located in the upper ureter in 4 RUUs, the middle ureter in 15, and the lower ureter in 27. Dilatation of a tight ureteral orifice was necessary in 17 cases (36.9%). RESULTS: On examination during ureteroscopy, all calculi were well fragmented, and in 33 patients (94%), stone fragments were removed directly. Stones were fragmented with pneumatic lithotripsy in 23 RUUs and removed by forceps with or without fragmentation in the remaining 23. Whereas the treatment was successful in 36 children (87.8%), it was unsuccessful in 5 (12.2%) secondary to bleeding and mucosal injury in 3 children (7%; 1 middle- and 2 upper-ureteral stones) and severe ureteral stenosis with kinking in 2 (4.8%; 1 middle- and 1 upper-ureteral stone) children. In two other cases, although the fragments in the upper portion of the ureter could be reached with the ureteroscope, the stones migrated into the renal collecting system during pneumatic lithotripsy and were treated successfully with subsequent SWL (4.8%). At the end of the procedure, a 4.8F Double-J stent was left in place in 9 cases. There were no serious complications, and the children were not specifically evaluated for postoperative vesicoureteral reflux. Follow-up ranged from 1 to 36 months with an average duration of 22.4 months. CONCLUSION: With the aid of the experience gained in the adult population and careful instrumentation, we believe that, in skilled hands, rigid ureteroscopy can be applied in a safe and efficient manner for stones located in different portions of the pediatric ureter.     

输尿管镜钬激光碎石术中并发输尿管穿孔原因及对策

目的探讨输尿管镜钬激光治疗输尿管结石并发输尿管穿孔的原因及防治方法。方法回顾性分析2004年8月至2006年12月经尿道输尿管镜钬激光碎石术268例中25例并发输尿管穿孔的临床资料。男14例,女11例;结石单发者21例,多发者4例;上段结石18例,下段结石7例;结石直径1．2～3．2em,平均（1．8±0．5）cm,25例均合并输尿管息肉及中、重度肾盂积水。术后常规放置双J管4—8周。结果25例输尿管镜手术时间15～70min,平均（40．4±18．3）min。11例一次性碎石成功,6例术中改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石治疗。结论输尿管结石合并息肉是输尿管镜钬激光碎石致输尿管穿孔的主要原因之一,术中轻巧操作是预防出现输尿管穿孔的关键,早期及时开放手术可以避免严重并发症的发生。