The impact of contemporary bladder management techniques on struvite calculi associated with spinal cord injury.

OBJECTIVE: To evaluate the incidence, risk factors and complications of upper tract struvite calculi, often associated with spinal cord injury (SCI), as such patients have a high incidence of urinary infection complicating their neurogenic voiding dysfunction, by reviewing a large population of patients with SCI in whom modern techniques of bladder management were used. PATIENTS AND METHODS: Between 1982 and 1996, 1669 patients with SCI were admitted to our institution; 1359 of these patients sustained their injuries during the study period. During this time, their bladder management was based on urodynamic and imaging criteria, using techniques such as early intermittent catheterization, sphincterotomy and bladder augmentation where possible to create a catheter-free, low-pressure reservoir. All instances of upper tract struvite calculi in this population were documented. Risk factors for stone development, presentation and complications, management and recurrence rates were assessed. RESULTS: Over the 15 years, 58 patients (3.5% of the SCI population) were treated for a total of 144 episodes of struvite calculi. The incidence of stones in those injured since 1982 was 1. 5%; 67% of these patients had complete spinal cord lesions, 54% had lesions of the cervical cord and 53% developed their first stone >10 years after injury. Only 22% presented within 2 years of injury. The group of patients developing stones had a significantly higher incidence of indwelling catheters (49%), bladder stones (52%) and vesico-ureteric reflux (28%) than those who were stone-free. The development of recurrent urinary tract infections was the most common mode of presentation. The stone-free rate after treatment was 87%. Normal renal function was preserved in 72% of patients. CONCLUSIONS: In a large population of patients with SCI managed using contemporary bladder techniques the incidence of upper tract calculi was 3.5%; 30% of these stones were complete or partial staghorns. Those patients with complete cord lesions, permanent indwelling catheters and vesico-ureteric reflux were at the highest risk. Stone clearance was 87% and recurrent stones occurred in 69% of patients. Struvite renal calculi continue to be a significant problem in the spinal cord injury population.     

Incidence of Urolithiasis in Northeast Thailand

Background :
Urolithiasis is a major health problem in the northeast part of Thailand. In this study, we examined the prevalence of renal stone disease and differences of urinary components between stone formers and healthy control subjects in northeastern rural areas of Thailand.
Methods :
We selected 3 villages in the rural areas of Khon Kaen province in northeast Thailand. Three hundred and sixty-seven persons were asked questions relating to urolithiasis and were examined by abdominal ultrasound (US). We collected a spot urine sample from stone formers and healthy control subjects from each village.
Results :
Abnormal findings by US were detected in 39 individuals (10.6%), and included 31 individuals with renal calculi (8.4%), 16 with hydronephrosis (4.4%), and 1 individual with a renal cyst (0.3%). This yielded a disease rate of urinary stones in this study of 16.9%. The male/female ratio was 2/1 and the average age of the individuals examined was 40.3 + 13.9 years. However, there was no significant difference between the urinary parameters of stone formers and the healthy control subjects. Conclusion: There was a high incidence of renal stone disease in the northeast part of Thailand, but the tendency for hypocitraturia was only found in stone formers.     

广东南海地区泌尿系结石患者结石成分分析(附986例报告)

【摘要】 目的 应用红外光谱法分析广东南海地区泌尿系结石患者的结石,为临床个性化防治泌尿系结石及复发提供理论依据。方法 通过自然排出、碎石后排出或手术取出获得结石样本986例,并应用红外光谱法对其行结石成分分析。结果 泌尿系结石患者男女比例为1.34∶1,51岁~60岁年龄阶段患者所占比例最高,上尿路结石发病人数明显多于下尿路结石,比例达9.49∶1。定性分析共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、无水尿酸、六水磷酸镁铵和胱氨酸6种化学成分。混合成分结石647例,占总人数的65.6%;含钙结石853例,占86.51%。草酸钙检出率最高,占77.38%,其次是碳酸磷灰石(5.27%)和尿酸(13.29%)成分。结论 采用红外光谱法分析泌尿系结石成分,对于了解结石成因、预防结石形成和复发具有重要的意义。     

Extracorporeal shock wave lithotripsy: the evolution of a revolution

Extracorporeal shockwave lithotripsy has now been in clinical use for 8 years, and it has replaced other treatment techniques for the majority of surgical calculi in the upper urinary tract. For the first time it provides a completely noninvasive method for the treatment of renal and ureteral calculi. The current range of indications means that approximately 70% of nonselected urinary stone patients can be treated by this method, while 25% of the patients with more complex stones in the upper urinary tract can receive treatment with the lithotripter combined with endourological procedures. The clinical role of this method is determined by a high success rate and minimal complications. This has led to a rapid worldwide acceptance in the urological community, and up to now more than 1.5 million patients with urinary stone disease have been treated.     

GERIATRIC UROLITHIASIS

Purpose

We define the differences between geriatric patients with urinary stone disease compared to a younger cohort.

Materials and Methods

A data base, including serum biochemical profiles, 24-hour urinalyses and standardized questionnaires, was retrospectively evaluated from more than 6,000 consecutive patients with urinary stone disease.

Results

Geriatric stone formers comprised 12% (721) of all stone patients. Two-thirds of these elderly patients had aberrant urinary values and 29% had isolated hypocitraturia compared to 17% in the younger group. Of geriatric stone forming patients 76% had recurrent urinary stones (mean 3.5 stone episodes), which was similar to the younger comparable group (77%, mean 3.3 stone episodes). The severity of urinary stone disease was similar between the 2 groups based on the need for urological intervention. Geriatric stone patients, in general, experienced the first stone episode later in life (after age 50 years) compared with younger patients. Elderly patients had an increased incidence of uric acid stones, but had a similar incidence of struvite calculi. Geriatric stone patients underwent parathyroid surgery more frequently (2.7 versus 0.7%). Geriatric stone forming patients rarely had renal failure.

Conclusions

The incidence, recurrence and severity of recurrent urinary stone disease were similar between geriatric and younger stone forming patients. Geriatric stone patients had an increased incidence of isolated hypocitraturia, uric acid calculi and previous parathyroidectomy. The geriatric stone population is not merely an extension of younger stone forming patients presenting at an older age. Rather, geriatric patients commonly experience the first symptomatic stone episode later in life.     

B超引导下经皮肾穿刺输尿管镜取石术治疗小儿上尿路结石的临床疗效分析

目的 探讨B超引导下经皮肾穿刺输尿管镜取石术治疗小儿上尿路结石的临床疗效和安全性.方法 回顾性分析2012年至2015年80例(82例次)小儿上尿路结石的临床资料,年龄7～71个月,平均(33.1±17.3)个月,结石大小(0.8～2.9) cm,平均(1.47 ±0.43)cm.左侧34例,右侧44例,双侧2例(无尿、肾功不全),单发结石46例,多发结石34例,肾盂、肾盏结石64例,输尿管上段结石5例,6例肾结石合并膀胱结石,4例肾结石合并有输尿管结石,1例肾结石合并同侧输尿管结石及膀胱结石,4例患儿既往有肾盂切开取石病史.先输尿管镜下患侧输尿管逆行留置4-5F输尿管导管,后俯卧位,B超引导下穿刺目标肾盏,16F Peel-away鞘作为手术通道,应用WOLF输尿管镜(WOLF 8/9.8F)气压弹道碎石取石.结果 手术治疗82例次,其中78例次一次取净结石,4例次先一期建立通道引流尿液改善肾功控制感染后二期取石,4例出现残留结石,术后第3天净石率为95.2％.手术时间(建立通道碎石开始手术结束)为15～ 90min,平均(33±21.7) min.术后HGB下降(9.8±7.8) g/L,HCT变化(0.0375±0.0367).术后平均住院时间3～11d,平均(6±1.6)d,术后1例患儿出现胸腔积液,15例出现发热,无严重并发症发生.术后随访1个月,患儿均未见结石复发.结论 B超引导下经皮肾穿刺输尿管镜取石术治疗小儿肾和输尿管上段结石安全、有效.     

Renal stones in children in Pakistan

One hundred and fifty children up to the age of 12 years with documented evidence of renal or ureteric stones were studied between July 1973 and June 1983. The peak age group was between 10 and 12 years, the male to female ratio being 1.9:1. Abdominal pain was the commonest presenting symptom (66.6%). Asymptomatic stones or vague symptoms in 23 patients warrant a higher index of suspicion of renal stone disease in children. Thirty patients had associated renal insufficiency. One third of the children had a positive urine culture, Proteus spp. being the commonest organism. Congenital anomalies of the urinary tract were seen in 12% of patients. In the majority (59%), aetiological factors related to stone formation could not be identified. One hundred and thirty patients underwent surgery for removal of stones. Analysis of calculi by X-ray diffraction and infrared spectroscopy revealed that stones were predominantly of mixed type, calcium oxalate being the commonest compound. The overall recurrence rate following surgical removal was 15%.     

经皮F16与F24肾造瘘通道治疗上尿路结石（附156例报告）

目的 探讨与评价F16、F24两种经皮肾造瘘通道治疗上尿路结石的方法与疗效。方法分别采用F16与F24两种经皮通道治疗上尿路结石156例。结果采用Ⅰ期、Ⅱ期，F16与F24两种经皮肾造瘘通道、输尿管镜及F20．8的经皮肾镜，用气压弹道及三代超声气压弹道碎石设备，成功处理156例上尿路结石，其中包括鹿角状结石、多发性肾结石、体外冲击波碎石（extracor-poreal shock wave lithotripsy，ESWL）治疗失败、孤立肾、马蹄肾结石、开放取石术后复发及输尿管上段结石，肾结石清除率89．8％，输尿管结石清除率99％。结论合理选择F16及F24两种经皮肾通道治疗上尿路结石，具有微创、恢复快、并发症少、安全性高的特点，可有效避免出血、感染等严重并发症，并可提高手术效率，两者结合效果更佳。     

Long-Term Incidence and Risks for Recurrent Stones Following Contemporary Management of Upper Tract Calculi in Patients with a Urinary Diversion

Purpose

The long-term rate of stone recurrence following contemporary minimally invasive management of calculi was determined in patients with urinary diversion and to identify specific risk factors for these recurrences.

Materials and Methods

We followed for a minimum of 12 months 25 patients (29 renal units) with upper tract calculi associated with urinary diversion, and treated with extracorporeal shock wave lithotripsy and/or percutaneous nephrostolithotomy. The risk of recurrent stones at 5 years was determined by a Kaplan-Meier estimate, while potential risk factors for recurrence were analyzed using a log-rank comparison.

Results

Stones recurred in 8 patients (32 percent) 18 to 61 months (mean 27.0) after treatment. The risk of new stone formation after 5 years was estimated to be 63.3 percent and was significantly greater in patients with recurrent bacteriuria after treatment. Neither stone history, type of procedure used, stone composition nor radiographic status of completion of treatment significantly influenced this risk.

Conclusions

Contemporary management of upper tract calculi in patients with a urinary diversion is associated with a high recurrence rate, especially among those with recurrent bacteriuria, regardless of whether the patient is initially rendered stone-free. Continued close surveillance and antibiotic prophylaxis seem to be essential in this high risk patient population.     

一期经皮肾镜碎石取石术治疗双侧上尿路结石

目的一期经皮肾镜碎石术治疗双侧上尿路结石的安全性及临床疗效。方法2004年7月～2008年12月,在X线或超声定位下采用经皮肾镜碎石术治疗双侧上尿路结石35例,其中双肾结石18例,一侧肾结石、一侧输尿管结石10例,双侧输尿管结石7例。截石位膀胱镜或输尿管镜下单侧或双侧输尿管留置输尿管导管,经皮肾镜手术均采用俯卧位,经输尿管导管注射生理盐水人造肾积水,在腋后线和肩胛下线之间第12肋上下区域行肾穿刺造瘘,建立F16～F32皮肾通道,在灌注泵生理盐水持续冲洗下,用输尿管镜或经皮肾镜,配合气压弹道或钬激光将结石粉碎。单个通道不易清石完全的肾多发结石或铸形结石,可以同样方式定位建立第2或第3条通道。结果本组35例70侧上尿路结石,单通道取石49侧,双通道取石18侧,三通道取石3侧。手术时间（单侧PCNL）：20～185min,平均66min。一次手术结石取净率为80%（56/70）。再次手术取石8侧,三期手术取石3侧,3侧肾结石少量残留未再次手术碎石取石。手术后总的结石清除率为91.4%（64/70）,其中输尿管结石24侧结石清除率100%（24/24）,肾结石46侧结石清除率87%（40/46）。无胸腹腔损伤、肠穿孔等周围脏器损伤的并发症。住院时间5～30d。术后随访3～6个月,B超及KUB＋IVP检查,未见结石复发。结论双侧上尿路结石采用经皮肾镜碎石取石治疗,安全、有效;在条件允许和技术成熟的前提下,可以施行一期治疗双侧上尿路结石。     

Clinical application of Therasonic lithotripsy treatment system for upper urinary tract calculi

Extracorporeal shock wave lithotripsy (ESWL) using a Therasonic lithotripter was performed on 30 patients with urinary tract calculi between July, 1989 and February, 1990. The results obtained in 31 cases (one patient had bilateral renal stones) were presented. There were 22 inpatients and 8 outpatients in this series. The stone location was: renal pelvis in 15 cases, renal calyces in 10 cases, parenchyma or diverticulum of renal calyces in 3 cases, ureteropelvic junction in 1 case, and upper ureter in 2 cases. Sixteen cases (52%) became stone-free and residual stones (less than or equal to 4 mm) remained in 9 cases (overall effective rate 81%) at one month after the treatment. There were no serious complications including bacteremia and renal hematoma. We concluded that Therasonic lithotripter is useful in the management of upper urinary tract calculi.     

Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial

BACKGROUND AND PURPOSE: To evaluate the efficacy of potassium citrate treatment in preventing stone recurrences and residual fragments after shockwave lithotripsy (SWL) for lower pole calcium oxalate urolithiasis. PATIENTS AND METHODS: One hundred ten patients who underwent SWL because of lower caliceal stones and who were stone free or who had residual stone 4 weeks later were enrolled in the study. The average patient age was 41.7 years. All patients had documented simple calcium oxalate lithiasis without urinary tract infection and with normal renal morphology and function. Four weeks after SWL, patients who were stone free (N = 56) and patients who had residual stones (N = 34) were independently randomized into two subgroups that were matched for sex, age, and urinary values of citrate, calcium, and uric acid. One group was given oral potassium citrate 60 mEq per day, and the other group served as controls. RESULTS: In patients who were stone free after SWL and receiving medical treatment, the stone recurrence rate at 12 months was 0 whereas untreated patients showed a 28.5% stone recurrence rate (P < 0.05). Similarly, in the residual fragment group, the medically treated patients had a significantly greater remission rate than the untreated patients (44.5 v 12.5%; P < 0.05). CONCLUSION: Potassium citrate therapy significantly alleviated calcium oxalate stone activity after SWL for lower pole stones in patients who were stone free. An important observation was the beneficial effect of medical treatment on stone activity after SWL among patients with residual calculi.     

延安地区泌尿系结石成分分析的研究

目的利用红外光谱法测定延安大学附属医院泌尿外科手术获得的泌尿系结石成分,探讨延安地区泌尿系结石成分与年龄、性别等关系,比较上、下尿路结石成分特点,分析延安地区泌尿系结石发生的流行病学情况,为临床制定有效的个体化治疗及预防措施提供参考依据。方法收集2013年1月至2017年1月在延安大学附属医院泌尿外科治疗1984例尿路结石患者的年龄、性别、结石部位等临床资料,对比分析延安地区泌尿系结石在不同年龄、不同性别、不同解剖部位的分布特点。结果在1984例泌尿系结石的患者中,按每10岁年龄大小分组排序,统计各年龄阶段泌尿系结石发病情况,男性患者有1346例,女性患者有638例,男性年龄(50.23±14.48)岁,女性年龄(47.87±14.51)岁,男、女患者比例约2.11∶1。在66~75岁年龄段,尿路结石发病率性别差异具有统计学意义(P<0.05)。结石成分以混合性结石为主,以混合性结石为主,共1582例,占79.76%。其中1665例(83.92%)为上尿路结石,上、下尿路结石的比例为5.22∶1,其余为肾结石合并膀胱结石。上尿路结石中男性1062例,女性603例,男女比例为1.76∶1;下尿路结石中男性284例,女性35例,男女比例为8.11∶1。青壮年(年龄≤45岁)泌尿系结石患者草酸钙为主结石、感染性结石多见;中老年(年龄>45岁)泌尿系结石者草酸钙为主结石、尿酸类结石多见。感染性结石患者性别差异具有统计学意义(P<0.05)。结论在延安地区男性较女性更容易患泌尿系结石。同时,不同年龄段结石构成成分具有差异。对于年龄≤45岁患者,主要以草酸钙为主结石、感染性结石多见,这与结石整体发病率基本一致;而对于年龄>45岁患者,主要以草酸钙为主结石、尿酸性结石多见。表明对于不同年龄段的结石患者,可以根据上述结果在结石的预防和治疗上综合考量,给予明确而更加合理的治疗。     

Course of calcium stone disease without treatment. What can we expect?

OBJECTIVES: The knowledge of the natural history (i.e. the course of the disease without metaphylaxis is the base for establishing rational guidelines for metaphylaxis in urolithiasis. METHODS: This review is based on a Medlinetrade mark Search (1966-1999) and the proceedings of the Bonn-Vienna and European symposia on urolithiasis. Only 31 references were sufficient for the purpose of this review. RESULTS: In idiopathic calcium stone disease, stone frequency without metaphylaxis is 0.10-0.15 stones per patient per year. The average recurrence rate is 30-40%. Recurrence rate increases with age and observation time. Risk for recurrence is highest during the first 4 years after the first stone episode. More than 50% of all recurrent stone formers have only one recurrence during their lives. 10% of recurrent stone formers have more than 3 recurrences. Risk factors for recurrence are: male sex, multiple and lower calyx stones, early onset, familial history, complications after stone removal. Metabolic evaluation is a poor predictor of the risk for recurrence. CONCLUSIONS: Renunciation of metaphylaxis is justified in first stone formers with idiopathic calcium oxalate and apatite stones. All patients, however, should be advised to increase their fluid intake.     

Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years

PURPOSE: In industrialized countries the prevalence of upper urinary tract stones has continually increased during the 20th century, but there are considerable differences between countries and also within the same country. To study whether there is still an increase in the frequency of renal stones, an investigation was undertaken to determine the prevalence of stone formers in a village near Milan, Italy, during two time periods, with an interval of 12 years. MATERIALS AND METHODS: Questionnaires were administered in 1986 and 1998 to all adult (age >25 years) occupants of two random samples of households in the village. Participants were asked whether they had experienced a kidney stone during their lifetime. RESULTS: The overall prevalence of stone formers among males was 6.8% in 1986 and 10.1% in 1998; that among females was 4.9% in 1986 and 5.8% in 1998. In all age classes, the respondents in the 1998 survey more frequently reported a history of stones than in 1986, but the prevalence of renal stones was significantly higher in 1998 than in 1986 only among males aged 31-40 and 51-60 years. The yearly incidence was estimated at 0.4%, with 0.6 and 0.18% in men and women, respectively. CONCLUSIONS: This marked increase in renal stones could be the result of environmental factors such as dietary habits and lifestyle, in particular the influence of an increased consumption of animal protein should be considered.     

Urinary calculi in renal transplant recipients

Urinary calculi are an uncommon complication in renal transplant recipients. During a 15-year period, in 544 cases of kidney transplantation with a functioning allograft for more than 3 months, and a long-term follow-up, we have observed 9 cases (1.7%) of urinary calculi. Calculi occurred in 6 male and 3 female patients, 6 patients were recipients of living related and 3 of cadaveric kidneys. Calculi were diagnosed as early as 3 months and as late as 3.5 years after transplantation, but most were detected within the first year. The location of the calculi was the bladder in 4 cases, the transplant in 3, and indeterminant in 2. Crystallographic analysis of retrieved stones revealed calcium oxalate and/or phosphate in 4 cases, triple phosphate in 2, and uric acid in 1. All patients had one or more stone-predisposing factors, such as obstructive uropathy and recurrent urinary tract infection (4 cases), hyperoxaluria (3), or hypercalciuria (2). During long-term follow-up (mean 60 months), only one patient lost the renal graft, 14.5 years after transplantation, primarily from causes unrelated to urinary calculi. One instance of stone recurrence was noted. In conclusion: (1) urinary calculi after renal transplantation are relatively uncommon; (2) predisposing factors and crystallographic composition of the calculi are identical in type, but not frequency, to those of nontransplant patients; and (3) with proper medical and surgical management, post-transplant urolithiasis does not appear to affect graft prognosis.     

ESWL与输尿管镜碎石联合处理上尿路结石

目的：探讨对部分上尿路结石采用ESWI．与输尿管镜碎石联合处理的方法。方法：对70例上尿路结石患者采用ESWI。与输尿管镜下钬激光碎石（URS）联合交替治疗。其中输尿管结石48例,。肾结石22例。结果：结石总排净率为91．4％00（64／70）,其中输尿管结石排净率为95．8％（46／48）,肾结石排净率为81．8％（18／22）。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWI,不佳,均改为PCNL术。结论：ESW[。与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWI,治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。     

The pathogenesis of calyceal diverticular calculi

Controversy exists over whether metabolic factors or urinary stasis predominate in the pathogenesis of calyceal diverticular calculi. We performed a study to better define the effects urinary stasis and metabolic abnormalities have in the pathogenesis of calyceal diverticular stones. Twenty-nine patients who underwent percutaneous treatment of calyceal diverticular calculi were studied. All patients underwent 24 h urine collection to evaluate metabolic risk factors. In three patients, urine was sampled directly from the diverticulum for metabolic studies. The urinary stone risk parameters of the patients with calyceal diverticular stones (Tic SF) were similar to those of a well-characterized cohort of calcium oxalate stone formers (CaOx SF). When compared to a group of normal people, the Tic SF and CaOx SF were significantly more hypercalciuric and their urine was significantly more supersaturated with calcium oxalate. Urine aspirated directly from the diverticulum had the lowest SSCaOx when compared to ipsilateral and contralateral renal pelves. The urinary risk profiles of patients with diverticular calculi are similar to those of CaOx SF, suggesting a metabolic etiology of diverticular stones. However, the SS CaOx of urine aspirated directly from the diverticula is significantly lower than that of the renal pelves; these data support the hypothesis that urinary stasis significantly contributes to the pathogenesis of calyceal diverticular calculi. Taken together, it seems likely that calyceal diverticular calculi arise from a combination of metabolic abnormalities and urinary stasis.     

Hypocitraturia as a pathogenic risk factor in the mixed (calcium oxalate/uric acid) renal stones.

A small group of patients with nephrolithiasis who forms mixed (calcium oxalate and uric acid) calculi presents particular problems in their clinical management. In 3,158 stones analyzed in our laboratory, we found 158 mixed calculi in 86 of the patients. In this work, the clinical and biochemical results obtained from 27 patients with mixed stones were compared with those from 27 control patients with calcium oxalate renal lithiasis. A significant difference was found in oxalate and citrate urinary elimination (mean +/- SD) in mixed stone formers versus pure calcium oxalate stone formers: oxaluria (mg/24 h: 38 +/- 15 vs. 28 +/- 12; p less than 0.01) and citraturia (mg/24 h: 214 +/- 139 vs. 437 +/- 303; p less than 0.01). Citraturia was decreased in a high proportion (77%) in mixed stone formers, and only a reduced percentage of them (23%) presented normal values, although in the low limit of normality. As treatment and prophylactic measure, we proposed oral administration of citrates in mixed stone patients because citrate inhibits spontaneous nucleation of calcium salts and crystal growth, and it also increases the urinary pH with a consequent increase in uric acid solubility.     

开放手术治疗上尿路结石667例回顾分析

目的 总结开放手术治疗上尿路结石的有效性,探讨在微创时代开放手术治疗上尿路结石的手术适应证.方法 回顾分析1995年1月至2004年12月在四川大学华西医院泌尿外科行开放手术治疗的上尿路结石病例.结果 共667例上尿路结石行开放手术治疗,同期约有9000例上尿路结石病例在我科治疗,开放手术比例约7.4%.开放手术原因包括:复杂结石及巨大结石297例,结石致患肾无功能137例,结石合并上尿路解剖畸形134例,微创治疗失败57例,结石合并各种内科疾病30例,结石合并肾肿瘤5例,结石合并黄色肉芽肿性肾盂肾炎3例,结石合并肾外伤2例,结石合并同侧其他手术2例.145例肾切除病例中共16例出现术中并发症,6例出现术后并发症;522例肾输尿管切开取石病例中,7例出现术中并发症,34例出现术后并发症;术后57例结石残留,总结石清除率为89.1%;围手术期无一例死亡.结论 开放手术在上尿路结石的治疗中仍然有重要作用,结石性无功能肾切除、复杂及巨大肾结石、结石合并解剖畸形、微创治疗失败及合并内科疾病的部分选择性病例适合选择开放手术治疗,治疗效果确切,并发症低.