Two years clinical experiences with extracorporeal shock-wave lithotripsy and transurethral ureterolithotripsy for ureteral stones at Osaka City University Hospital

From July 1985 to June 1987, 303 patients with ureteral stones were treated by either extracorporeal shock-wave lithotripsy (ESWL) or transurethral ureterolithotripsy (TUL). The ureteral stones were classified into two groups, upper and lower ureteral stones. The upper ureteral stone was defined as a stone located above the pelvic brim in radiological examinations. ESWL was performed using a Dornier lithotriptor HM-3. For TUL, following the insertion of a guide wire and dilatation of the intramural ureter by ureteral bougie, a ureteroscope was introduced into the ureter. The success rate included both patients who became stone free and patients whose stones were disintegrated into less than 4 mm. The success rate of ESWL for upper ureteral stones was 90%, and 8.5% were treated subsequently by TUL. The success rate of TUL for upper ureteral stones was 42%, and the remaining required another session of TUL or another procedure, mainly ESWL. On the other hand, the success rate of TUL for lower ureteral stones was 71%, and the remainder also required another session of TUL or another procedure, mainly ESWL. The efficacy of TUL for stone street was comparably low by the evaluation done at 5 days after the procedure. However, almost all patients with stone street, which had developed after ESWL treatment, became stone free several weeks after TUL and insertion of a stent catheter. Major complications or side effects for ESWL were fever of more than 37.5 degrees C (7.5%) and pain attacks (8.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical results of transurethral ureterolithotripsy using pulsed-dye laser: primary ureteral stones versus secondary ureteral stones after ESWL

Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.     

Transurethral ureteroscopic removal of ureteral calculi

Rigid ureteroscopy was used for transurethral removal of ureteral stones. Calculi were extracted under direct vision using flexible grasping forceps or a stone basket. If the size of the stone precluded the use of these techniques, we disintegrated the stone using an electro-hydraulic lithotriptor (EHL) or ultrasonic lithotriptor (USL). Between January, 1985 and October, 1985, 35 ureteroscopic procedures were performed for removal of ureteral stones. In 27 cases (77%) the stone was removed successfully. All stones could be removed in mid and lower ureter. However, in upper ureter, the success rate was only 50%. In 8 instances, ureteroscopy failed to remove the ureteral calculus and 6 underwent percutaneous nephrolithotomy, 2 open surgery. Of the ureteral stones, 12 were removed with grasping forceps or a basket manipulation. EHL and USL were used successfully to remove calculi in 15 cases. To make smooth passage of the ureteroscope, a 6F UPJ occlusion balloon catheter was introduced into the ureter and the balloon was inflated in the intramural ureter for 24 hours preoperatively. We have found this to be a useful procedure for smooth passage of the ureteroscope. Most common complication of ureteroscopic stone removal was fever (29%). In 1 case, the ureter was penetrated by the scope. The patient was treated with an indwelling ureteral catheter for 2 weeks. After the catheter was removed, an excretory urogram demonstrated normal ureter without extravasation or obstruction. We conclude that ureteroscopic stone removal can be done safely with careful passage of the scope and careful manipulation of calculi.     

New classification of ureter by success rate for transurethro-ureteral lithotripsy

Between August, 1985 and February, 1987, 4 renal pelvic stones and 49 ureteral stones (28 calculi in the abdominal ureter, 21 in the pelvic ureter) were treated by 55 procedures of transurethro-ureteral lithotripsy (TUL). The success rate for stones in the ureter lying in the paravertebral gutter was 33% (3/9), while those in the ureter overlying the psoas muscle was 85% (17/20). The success rate for calculi impacted at the uretero-vesicle junction was 100% (12/12), and those in the upper part of pelvic ureter was 80% (8/10). Two of 4 renal pelvic stones were successfully fragmented and removed. The overall success rate by the ureterorenoscope was 79% in 53 renoureteral units. Judging from our experience and results of TUL, the stone location seems to be one of the factors affecting the success rate. Thus, we propose a new classification of ureter according to success rate for TUL as follows; uretero-vesical junction, pelvic, psoas, and gutter portion.     

Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones]

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)     

6/7.5 F输尿管镜联合输尿管导管负压吸引治疗输尿管上段结石216例报告

目的探讨应用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石的安全性及有效性。 方法回顾性分析深圳市前海蛇口自贸区医院2019年1月至2020年12月采用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引配合钬激光碎石治疗输尿管上段结石患者216例的临床资料。留置5 F输尿管导管越过结石上方,连接负压吸引,应用200 μm钬激光击碎结石。 结果216例患者中,术中共209例输尿管镜成功到达结石下方位置,上镜成功率96.8%;18例因整体或大部分结石移位至肾盂,一期行输尿管软镜碎石,结石上移率8.3%;术后低热5例,高热1例,感染率2.7%;拔管后20例KUB提示有>4 mm结石残留,清石率90.7%;所有病例均无输尿管穿孔、黏膜撕脱、感染性休克等严重并发症。 结论6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石安全、有效,可降低结石上移逃逸率,提高术后清石率,减少术后感染,临床效果确切。     

Electrohydraulic lithotripsy of upper urinary tract calculi

Electrohydraulic lithotripsy (EHL) was employed for the treatment of 35 patients with upper urinary tract calculi. The stones in 14 patients with renal and upper ureteral calculi were disintegrated by a 9Fr probe and the rigid nephroscope. Twelve patients with upper or middle ureteral calculi were treated using a 5Fr probe and the fiberscope. The stones in 9 patients with lower ureteral calculi were removed by a 5Fr probe and the rigid ureteroscope. Although small residual stones were observed in 15 patients (43%), all the stones were fragmented satisfactorily except in two patients. The complications due to EHL were observed in eight patients (23%). The most frequent complication was the ureteral injury which was observed in 6 patients. In 2 of these patients the stone migrated out from the ureter. However, all the cases of ureteral injury were healed by the conservative therapy such as by indwelling the stent catheter without ureteral stricture.     

PercSys型输尿管管路封堵器在输尿管镜钬激光碎石治疗输尿管结石中的应用

目的探讨PercSys型输尿管管路封堵器在输尿管镜钬激光碎石治疗输尿管结石的价值和安全性。方法2011年9月～2012年5月,83例单侧输尿管结石（下段12例,中段21例,上段50例）,Wolf F8.0/9.8输尿管镜在斑马导丝引导下进入输尿管见到结石后,于输尿管镜工作通道内放置PercSys型输尿管管路封堵器,封堵叶片完全超越结石后操作体外手柄使叶片折叠成球状防止结石上移,科医人钬激光完全粉碎结石至直径1～2mm碎片后松开封堵器,拔除封堵器后留置双J管。所有患者术后留置双J管2周。术后4周复查泌尿系彩超或上尿路螺旋CT平扫,残留结石直径〉3mm为有意义的结石残留。结果所有患者均通过输尿管镜工作通道成功放置输尿管管路封堵器并行钬激光碎石。放置管路封堵器时间1～3min,碎石时间3～10min。术中未发生输尿管穿孔或输尿管黏膜撕脱,术后无发热及菌血症发生。术后第4周复查泌尿彩超或泌尿系螺旋CT,除5例输尿管上段有较大碎石漂移人肾盏未排空外,其余78例无结石残留,结石清除率为93．9％（78／83）。所有封堵器均未发生封堵折叠和松开退出不成功机械故障。结论PercSys型输尿管管路封堵器操作简单、方便,可对输尿管结石产生有效封堵,预防输尿管结石碎石术中结石漂移。     

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.     

Short-term ureteral catheter stenting after uncomplicated transurethral uretero-lithotomy

Short-term (1 or 2 post-operative days) ureteral catheter stenting after transurethral uretero-lithotomy (TUL) to avoid flank pain due to transient ureteral edema is described. Patients who underwent TUL for middle or distal ureteral stones with a rigid ureteroscope without complications during the procedures were the candidates for short-term ureteral stenting. An end-hole ureteral catheter, used to insert a guide wire during TUL, were used for stenting. The tip of the catheter was located near the renal pelvis and the other end was introduced outside through the urethra with a 14 F urethral catheter. The stent and catheter were removed on post-operative day 1 or 2. For the 18 patients treated using this method, the time of analgesic use after stent removal was 0.6±0.8, indicating a sufficient duration of stenting. Short-term ureteral catheter stenting is a cheap and easy way for post-operative management for uncomplicated TUL.     

输尿管硬镜临床运用418例体会

目的：提高输尿管硬镜临床运用技术。方法：回顾分析输尿管硬镜诊治418例输尿管疾病的临床资料。结果：采用输尿管导管引导,手控间断式水压扩张法直接进镜。手术成功率为97.0%。手术中并发输尿管穿孔2(0.5%)。结论：输尿管硬镜进镜时采用输尿管导管引导,手控间断式水压扩张法直接进镜,可简化操作,缩短手术时间,手术成功率高,并发症少,且可避免因灌注压过大而致结石上移。根据输尿管病变的不同,采用相应的治疗方法,疗效满意。     

输尿管镜气压弹道碎石术治疗输尿管结石412例报告

目的：探讨输尿管镜（URS）气压弹道碎石术治疗输尿管结石的临床疗效。方法：采用URS取石或配合气压弹道碎石术治疗输尿管结石患者412例。结果：一次性碎石取石成功率为88．3％，其中输尿管上段结石为56．3％（18／32），输尿管中段结石为87．9％（80／91），输尿管下段结石为97．1％（266／274），并发症主要为术后发热（13例），肾绞痛（9例），及血尿等。结论：URS气压弹道碎石术治疗输尿管结石安全有效，损伤小，是治疗输尿管中下段结石的好方法。     

U100激光碎石治疗输尿管结石的效果观察

目的:探讨输尿管镜下应用U100激光治疗输尿管结石的疗效。方法:对382例输尿管结石患者在输尿管镜下应用U100激光进行碎石治疗。结果:输尿管结石382例中,356例结石一次性粉碎成功,碎石成功率为93.2%。其中,输尿管上段结石一次碎石成功率为88.1%(104/118),中、下段结石一次碎石成功率为95.5%(252/264)。全部激光碎石成功的患者术后除出现血尿外,均无其他严重并发症发生。结论:U100激光碎石治疗输尿管结石具有快速、高效、安全、创伤小、操作简单等优点,可作为输尿管结石的首选治疗方法。     

Treatment of ureteral calculi by extracorporeal shock wave lithotripsy at a multi-use center

We reviewed our experience with extracorporeal shock wave lithotripsy therapy in 138 patients who presented with mid and upper ureteral calculi. In the patients who had successful stone manipulation back into the renal collecting system the success rate was significantly higher compared to that for stones treated primarily within the ureter (92.8 versus 80.8 per cent, p less than 0.05). Among the stones treated within the ureter the success rates appeared to be similar for stones treated in situ (83.3 per cent) compared to those treated when a catheter could be placed alongside the calculus (79.3 per cent). Higher voltage and more shock waves were administered to stones treated within the ureter compared to stones that were manipulated back into the kidney. However, this increase power did not enhance the success rate. In addition, it appears that a plain film of the abdomen obtained within 24 hours of lithotripsy treatment is a good predictor of success as defined by the rate free of stones at 6 weeks of followup. Our results from a community-based multi-use lithotripsy center suggest that ureteral stone manipulation should be attempted before extracorporeal shock wave lithotripsy for mid and upper ureteral calculi.     

输尿管镜下电子动能弹道碎石术治疗输尿管结石

目的探讨输尿管镜下电子动能弹道碎石治疗输尿管结石的疗效。方法2002年9月~2008年7月对381例输尿管结石采用日本Olympus F8.4/9.8输尿管硬镜结合德国WALZ.KA.1000型电子动能碎石机进行碎石。根据结石的大小及硬度,采用A~C档,将结石击碎至直径3 mm以下（碎石杆作参照）,较大的石碎用取石钳取出,输尿管镜通过结石嵌顿部位后继续上行至肾盂,退镜后顺导丝放置F5双J管3~4周,术后留置尿管2~3 d。结果碎石成功率95.5%（364/381）,其中上段结石碎石成功率89.7%（52/58）,中段为94.2%（129/137）,下段为98.4%（183/186）,17例结石冲回肾盂,结合体外冲击波治疗。365例随访3~12个月,平均5个月,1个月内结石排净为100%,未出现输尿管狭窄、尿路感染等并发症。结论输尿管镜下电子动能弹道碎石术治疗输尿管结石方法安全,疗效可靠。     

腔镜下球囊导管辅助钬激光治疗输尿管中段和上段结石76例

目的探讨在输尿管镜下碎石术中使用输尿管球囊导管阻止结石移位的效果。方法 2010年5月～2011年8月,对76例输尿管中段和上段结石,使用Wolf F8/9.8输尿管硬镜,F4输尿管球囊导管阻止结石移位,国产腔内灌注泵灌注使视野清晰,65 W钬激光碎石。结果 71例一次碎石成功,成功率为93.4%（71/76）,术后2～8周拔除双J管时复查B超或泌尿系平片检查,均无输尿管结石残留。5例未成功：3例上段结石上移到肾盂（1例为钬激光击中球囊致球囊破裂后结石移位,2例放球囊前结石已经被冲入肾盂）改ESWL治疗,1例因输尿管穿孔、1例因输尿管开口变异无法上插输尿管镜改开放手术。结论输尿管镜钬激光碎石术中使用输尿管球囊导管,可以阻止结石移位。     

Transureteral lithotripsy in pediatric practice

PURPOSE: The present study reviews ureteroscopy intervention for the treatment of ureteral stones in pediatric patients in the last 6 years at three institutions in Iran. PATIENTS AND METHODS: Sixty-six ureteroscopies were performed in 66 prepubertal patients (mean age 9 years; range 2-15 years) with a male/female ratio of 31/35. Ultrasonography, plain film, or intravenous urography was performed in all cases. The mean stone size was 8 mm (range 5-15 mm). All the interventions were performed under general anesthesia with semirigid ureteroscopes of 8F to 11.5F. The stone was located in the left ureter in 32 patients and in the right in 34 patients. Stones were located in the distal ureter in 59 patients, in the midureter in 5, and in the proximal ureter in 2. Before ureteroscopy, ureteral dilatation with a balloon was done to 12F if necessary. If the calculus could not be removed with the basket (stone.8 mm), lithotripsy using ultrasonic, electrohydraulic (EHL), or pneumatic equipment was performed. RESULTS: Ureteroscopy with an 11.5F, 9F, 8.5F, or 8F ureteroscope were performed in 26, 14, 5, and 21 patients, respectively, and ureteral dilatation was necessary in 23, 0, 0, and 2 cases, respectively. We were unable to introduce the ureteroscope into the ureter in three patients (two boys with an 11.5F ureteroscope and one girl with an 8.5F ureteroscope) with distal ureteral stones. The stones moved to the kidney in four patients. Stone management was with basketing alone in 14, EHL in 3, ultrasonic lithotripsy in 8, and ballistic lithotripsy in 34 patients. The stone-free rate was 88% (58 patients) at 48 hours postprocedure. The complication rate was 23% and included renal colic (1), gross hematuria (11), and pyelonephritis (3). No patient had obvious perforation or stricture of the ureter at 3-month follow-up. CONCLUSION: Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of ureteral calculi in children. Ureteroscopic treatment, especially with a small-caliber ureteroscope, should be considered the first choice for treatment of calculi in the distal ureter in children.     

输尿管镜下气压弹道碎石治疗输尿管结石

目的 探讨输尿管镜下气压弹道碎石治疗输尿管结石的治疗效果. 方法 我院2002年8月～2006年4月采用Wolf F8/9.8硬性输尿管镜联合瑞士EMS气压弹道碎石机碎石治疗输尿管结石158例163侧.采用椎管内麻醉,生理盐水作为冲洗液,输尿管镜进入输尿管,到达结石处后,气压弹道击碎并取出结石,并上行观察输尿管全长,术后留置双J管引流.结果手术时间15～90 min,平均40 min.碎石成功率96.9%（158/163）,其中输尿管上段结石碎石成功率86.6%（13/15）,中段结石碎石成功率96.9%（46/49）,下段结石碎石成功率100%（99/99）;2例输尿管上段结石移位至肾盂内,留置双J管后行体外冲击波碎石,其余3例为结石被击碎后,残余小结石进入肾盂,留置双J管后行药物排石或体外冲击波碎石.术中出现输尿管穿孔3例（1.8%）,留置双J管引流后治愈;无输尿管粘膜撕脱、断裂、周围血管脏器损伤等严重并发症,无中转开放手术.125例随访1～38个月,平均15个月,B超或KUB检查,无结石复发. 结论输尿管镜下气压弹道碎石具有碎石成功率高,创伤小,手术时间较短等优点,是治疗输尿管结石的一种安全、有效的方法.     

输尿管软镜在治疗输尿管上段漂移结石中的应用

目的 探讨输尿管软镜下钬激光碎石治疗输尿管上段漂移结石的疗效和安全性.方法 2004年11月～2012年11月,在输尿管硬镜钬激光治疗输尿管上段结石中有63例结石或＞5 mm残余结石漂入肾盂,在输尿管扩张鞘或Flexor输尿管导入鞘帮助下置入输尿管软镜62例,因输尿管细沿导丝置入输尿管软镜1例,应用钬激光碎石治疗.结果 输尿管软镜下钬激光同期碎石成功率81.0％ (51/63).败血症1例,肾周包膜下血肿1例,无大出血、输尿管撕脱或断裂.结论 输尿管软镜下钬激光碎石是在输尿管硬镜碎石时对漂入肾盂内结石或残余结石的安全、有效的治疗手段.     

输尿管软镜下钬激光碎石处理直径〉2cm肾结石

目的 探讨输尿管软镜下钬激光碎石术处理直径〉2 cm肾结石的安全性和可行性.方法 2010年2月～2013年4月,采用输尿管软镜下钬激光碎石术处理经选择的直径〉2 cm的肾结石35例.先用F8.0/9.8输尿管硬镜探查、扩张患侧输尿管,置入导丝后留置输尿管软镜鞘,引入输尿管软镜进行钬激光碎石,较大、影响视野的结石碎屑用套石网篮取出.结果 一次进镜成功率94.2%（33/35）.手术时间35~95 min,平均45 min.4例因术后残留较大体积结石再次输尿管镜下钬激光碎石.术后4例出现高热,经积极抗感染治疗后好转,无一例出现术中严重并发症.术后住院1~5 d,平均3 d.术后8周随访,结石清除率90.9%（30/33）;2例少量残留结石碎片停留于输尿管中下段,拔除内支架管时同时取出;1例孤立肾结石术后18周随访（术后8周已拔除内支架管）,仍有结石碎片在输尿管下段未排出,局麻下输尿管镜钳夹取出.结论 输尿管软镜碎石术治疗经选择的直径〉2 cm肾结石,安全、有效,特别对于术后复发的肾结石患者可以避免再次肾脏手术损伤.