Comparison of pneumatic and Holmium laser ureteroscopic lithotripsy for upper third ureteral stones

ObjectiveTo evaluate the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter and Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper third ureteral stones.Materials and methodsPatients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper third ureteral stones were retrospectively reviewed. Patients with urinary tract infection, radiolucent stones, loss of follow-up, concurrent middle or lower third ureteral stones or acute renal failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups.ResultsThere were 158 patients with 178 upper third ureteral stones (135 in pneumatic lithotripsy group and 43 in Ho:YAG laser lithotripsy group) meeting the study criteria. Patients' age, gender, stone laterality, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less secondary intervention rate as compared with pneumatic lithotripsy (53.4% vs. 40.1%; 72.1% vs. 91.9%; 25% vs. 48.5% respectively, all p < 0.05). In patients with stones larger than 10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate.ConclusionsHo:YAG laser lithotripsy is superior to pneumatic lithotripsy in the management of upper third ureteral stones in terms of double J stent insertion rate, stone free rate and secondary intervention rate for stones of all sizes. For stones larger than 10 mm, laser lithotripsy results in less stone upward migration.     

Preoperative stenting for ureteroscopic lithotripsy for a large renal stone

A large renal stone can be treated ureteroscopically, but the treatment often requires more than one procedure. The use of stenting before ureteroscopy was recently reported. The present study investigated the effectiveness of preoperative stenting before ureteroscopic lithotripsy for large (>15 mm) renal stones. A ureteral stent was intentionally inserted in 25 patients undergoing ureteroscopic surgery. A group of 36 non‐prestented patients was used as control. Median stone diameter was 21 mm in both groups. Pre‐ureteroscopy stenting significantly improved the stone‐free rate, defined as stones <2 mm and <4 mm (P < 0.05), whereas it did not significantly improve the stone‐free rate defined as 0 mm (P = 0.12). The uretereoscopy success rate was 72.0% in the stented and 55.6% in the control group (P = 0.09). A 14/16‐Fr ureteral access sheath was successfully inserted in 94.7% of the stented patients, and 74.2% of the non‐stented patients (P < 0.05). Our findings showed that preoperative stenting is effective for dilation of the ureter, and also to facilitate the insertion of a ureteral access sheath in patients undergoing ureteroscopic lithotripsy for large renal stones.     

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.     

Indications of stented uncomplicated ureteroscopic lithotripsy: a prospective randomized controlled study

The purpose of our trial was to evaluate whether stents could be eliminated after uncomplicated ureteroscopic lithotripsy for ureteral stones and the indications of ureteral stent placement. A total of 228 patients underwent uncomplicated ureteroscopic intracorporeal lithotripsy. After the procedures, patients without marked ureteral edema, polypoid change or stent placement were treated as a control group. The other patients were randomized to two groups. Patients were followed on the first postoperative day, 6 and 12 weeks, postoperatively. In stented cases the stent was removed after 1 week. Outcome measures included visual analog scale assessment, postoperative analgesic requirements, complications and the stone-free rate. On the first postoperative day the symptoms of flank pain, dysuria and frequency were significantly greater in the stented group (P < 0.0001). The overall perioperative complication rate, including fever, pyuria, flank and loin pain, was 3.3% (3/90) in group 1, 16.9% (12/71) in group 2, and 41.8% (28/67) in group 3. We believe that in selected patients undergoing ureteroscopy for ureteral stone, stents can be safely omitted. Patients without stents have significantly less stent-related symptoms and are not at higher risk of complications with smooth ureteral mucosa. When there is ureteral edema or polypoid change with pyuria, ureteral stents should be indwelled to avoid severe postoperative complications.     

Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial

We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclsion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.     

输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的疗效比较

目的 比较输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的临床效果.方法 回顾分析2009年1月至2011年2月输尿管镜下治疗输尿管结石459例临床资料,其中钬激光碎石术267例(312侧),气压弹道碎石术192例(220侧).结果 钬激光组260例(305侧)碎石成功,碎石总成功率97.76%;气压弹道组177例(205侧)碎石成功,碎石总成功率93.18%.术后4~6周随访,两组结石排净率分别为98.69%、94.15%,碎石成功率、结石排净率均有显著性差异.结论 输尿管镜下钬激光和气压弹道碎石术均是治疗输尿管结石的好方法,但在碎石成功率、结石排净率以及在处理输尿管结石合并息肉、狭窄时,钦激光具有更大的优势.     

一期软性输尿管镜治疗上尿路结石的置鞘成功率及疗效分析

目的探讨术前未预置双J管一期软性输尿管镜治疗上尿路结石置鞘成功率及临床疗效。 方法回顾性分析2018年1月至2020年6月在绍兴文理学院附属医院行一期软性输尿管镜碎石的255例上尿路结石患者的临床资料，分析一期置鞘成功率、一期手术成功率、结石清除率及并发症发生情况。 结果8.5 F软性输尿管镜碎石，一期置鞘总成功率为92.9%（237/255）。其中10/12 F组置鞘成功率91.6%（141/154例），置鞘成功和失败患者之间性别差异有统计学意义（P<0.05）；12/14 F组置鞘成功率95%（96/101例），置鞘成功和失败患者之间在术前肾积水和肾功能方面差异有统计学意义（P<0.05），进一步行多因素Logistic回归分析表明性别（P=0.014）是置鞘失败的独立危险因素。一期手术成功率为85.5%（218/255），术后3个月清石率88.5%（177/200）。总并发症发生率为23.5%（60/255），术中输尿管1级损伤25例，2级损伤6例，3级损伤1例；术后发热22例，其中全身炎症反应综合征5例，尿源性脓毒血症1例；出现包膜下血肿1例；出现肾功能不全5例；未出现感染性休克、输尿管石街和输尿管狭窄等严重并发症。 结论不预留双J管一期软性输尿管镜碎石治疗也具有较高的置鞘成功率及手术成功率，清石率高，安全可靠，女性患者置鞘成功率更高。     

预置D-J管分期碎石治疗输尿管嵌顿结石的临床研究

目的比较一期输尿管镜碎石与预置D-J管后二期输尿管镜碎石治疗嵌顿性输尿管结石的临床效果。方法将96例嵌顿性输尿管结石患者按手术方法的不同分为两组,一期碎石组48例,二期碎石组58例。比较两组一次性清石率、手术时间、术后住院时间、并发症发生率等指标。结果两组比较,二期碎石组一次性清石率及手术时间比较并发症发生率、术后住院时间、住院费用等指标均优于一期碎石组,比较差异均有统计学差异(P<0.05)。结论输尿管硬镜联合输尿管软镜钬激光碎石治疗输尿管嵌顿性结石有良好效果,预先置管可进一步提高临床疗效。     

A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy

PURPOSE: A prospective randomized controlled trial was performed to determine whether stents may be eliminated after uncomplicated ureteroscopic lithotripsy for ureteral stones. MATERIALS AND METHODS: A total of 58 patients underwent uncomplicated ureteroscopic intracorporeal lithotripsy. After stone fragmentation patients were randomized to a nonstented (29) or a stented (29) treatment group. Intracorporeal lithotripsy was performed with the holmium laser in 57 cases and by electrohydraulic lithotripsy in 1 without balloon dilation or the extraction of stone fragments. Patients were followed 1, 6 and 12 weeks postoperatively. In stented cases the stent was removed at 1 week. Outcome measures included postoperative symptoms assessed with a visual analog scale, postoperative analgesic requirements, complications and the stone-free rate. RESULTS: At 1 week the symptoms of flank pain, abdominal pain, dysuria and frequency were significantly greater in the stented group (p <0.005). There were no differences in symptoms in the groups at subsequent followup visits. There was no difference in treatment groups in terms of the amount of analgesic required in the recovery room or during 1 week after ureteroscopy. Similarly there was no difference in the number of patients requiring antiemetics. One patient in the stented group required hospitalization for genitourinary sepsis and 1 patient in the nonstented group visited the emergency room for postoperative vomiting. The stone-free rate was 100% in each group. CONCLUSIONS: These results demonstrate that after ureteroscopic intracorporeal lithotripsy with the holmium laser patients with a stent have significantly greater irritative and painful symptoms than those without a stent in the early postoperative period. There was no difference in nonstented and stented ureteroscopy with respect to complications or stone-free status. Therefore, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not required as long as the procedure is uncomplicated and performed without balloon dilation of the ureteral orifice.     

膨宫机在输尿管镜手术处理输尿管结石合并息肉的应用价值

目的 评价膨宫机在输尿管镜碎石取石术处理输尿管结石合并息肉中的应用价值,探讨输尿管结石合并息肉的处理技巧.方法 回顾我科行输尿管镜碎石取石术术中发现结石合并息肉的52例患者临床资料,其中输尿管上段结石18例,中下段结石34例,25例采用膨宫机持续灌注生理盐水扩张法行弹道碎石取石术(膨宫机辅助组),27例采用挂高水袋配合人工注水扩张法行弹道碎石取石术(传统碎石组);两组术中均常规留置双J管;比较两组的总手术时间、碎石时间、结石清除率、术中及术后并发症情况.结果 52例患者均全部成功碎石,无一例中转开放手术,两组均无输尿管断裂、撕脱并发症发生,传统碎石组1例术中发生输尿管穿孔.膨宫机辅助组与传统碎石组的总手术时间分别为31.2±5.1 VS 37.0±6.2 min (t=-3.68,P=0.0006<0.05),碎石时间分别为6.5±1.4 VS 9.4±1.5 min(t=-7.19,p=0.0000<0.05);传统碎石组有1例上段结石术中上移至肾盂,术后采用体外冲击波碎石清除结石.两组患者术后均得到3个月~1年随访,超声复查均未见结石残留及输尿管狭窄并发症发生.结论 术中应用膨宫机持续灌注生理盐水扩张输尿管结合一定的弹道碎石技巧能使术野保持清晰,可明显减少总手术时间、碎石及清石时间,疗效确切,在输尿管镜处理输尿管结石合并息肉中有重要的临床应用价值.     

输尿管气囊导管在输尿管镜碎石术治疗输尿管上段结石中的应用（附36例报告）

目的探讨输尿管气囊导管在输尿管镜碎石术治疗输尿管上段结石中的应用价值。方法对36例输尿管上段结石术中使用输尿管气囊导管防止结石上移。结果34例有效地预防了结石的上移,一次性碎石成功,成功率为94.4%（34/36）。结论输尿管镜碎石术治疗输尿管上段结石术中使用输尿管气囊导管,可以有效地防止结石上移,提高碎石的成功率,同时也可减少菌血症的发生和促进术中结石排出,值得在临床上推广。     

Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial

PURPOSE: We conducted a prospective, randomized controlled study to investigate the advantages and disadvantages of ureteral stenting after ureteroscopic lithotripsy. MATERIALS AND METHODS: A total of 60 patients who underwent ureteroscopic lithotripsy were equally randomized into a stented or a nonstented group. The inclusion criteria were stone 6 to 10 mm., absence of polyp or stricture in the ureter and no mucosal injury during ureteroscopy. The operation was performed with a 6Fr rigid ureteroscope without ureteral dilation and stones were fragmented with a 1.9Fr electrohydraulic lithotriptor without extraction. A 7Fr double pigtail stent was placed in the stented group for 3 days after ureteroscopy. Urinalysis, plain x-ray and renosonography were performed before and after lithotripsy in each patient. Subjective symptoms and pain score were recorded on admission to the hospital and 3 days postoperatively. RESULTS: The stone-free rate was 100% in each group and preoperative hydronephrosis equally resolved in both groups. Mean pain score plus or minus standard deviation improved significantly in the nonstented (6.33 +/- 1.81 preoperatively to 2.30 +/- 1.93 postoperatively, paired Student's t test p <0.0001) and stented (7.10 +/- 1.03 to 2.30 +/- 2.22, p < 0.0001) group. There was no statistical difference in pain reduction between the 2 groups (p = 0.18). The amount of extra parenteral analgesic used was similar in both groups. One patient in the nonstented group visited the emergency room for postoperative renal colic, 25 (83.3%) patients in the stented group complained of at least 1 irritative bladder symptom and only 4 (13.3%) in the nonstented group experienced bladder discomfort. CONCLUSIONS: After uncomplicated ureteroscopic electrohydraulic lithotripsy patients without ureteral stenting tend to have similar renal function recovery and satisfactory pain reduction with less irritative symptoms compared to those treated with a ureteral stent. We suggest that it is not necessary to place a ureteral stent routinely after uncomplicated ureteroscopic electrohydraulic lithotripsy for stones smaller than 1 cm.     

输尿管镜电子动能碎石182例报告

目的：探讨输尿管镜下电子动能碎石术治疗输尿管结石的疗效。方法：对182例(198侧)输尿管结石患者采用输尿管镜下电子动能碎石术治疗。结果：一次性碎石成功率为95.0%(188／198)，并发症发生率为4.0%(8／198)，其中穿孔2侧。结论：输尿管镜下电子动能碎石术是治疗输尿管结石的一种安全、疗效确切的方法。     

输尿管软镜日间手术输尿管支架留置时间研究

目的日间手术行输尿管软镜碎石后输尿管支架留置时间为1周的可行性研究。方法选择2017年1月至2018年5月于本院进行的日间手术输尿管镜检+软镜钬激光碎石术患者188例,将患者随机纳入输尿管支架管留置时间的周组与月组,术中使用奥林巴斯输尿管纤维软镜,钬激光将结石充分粉碎,套石篮取出碎石粒,留置输尿管支架管引流,根据分组时间拔除。结果188例手术患者都于24 h内出院,周组与月组患者年龄、结石最大直径、手术时间、手术出血量比较差异均无统计学意义(P>0.05),术后均无严重感染等并发症发生,术后1个月,复查排石效果,两组差异无统计学意义(P>0.05),周组相关并发症少于月组(P<0.05)。结论通过优化措施的日间手术行输尿管软镜碎石术后输尿管支架留置时间为1周,留置尾线,安全可行,是一种值得推荐的经验。     

输尿管镜与后腹腔镜手术治疗输尿管上段结石的疗效比较

目的 比较输尿管镜碎石取石术与后腹腔镜输尿管切开取石术治疗单侧输尿管上段结石的疗效,探讨两种术式的适应证及技术要点.方法 收治64例单侧输尿管上段结石患者,随机分成两组,32例行腰硬麻下输尿管镜钬激光碎石取石术,32例行气管全麻下后腹腔镜输尿管切开取石术,两组术中均留置双J管,比较两组的手术时间、术后住院时间、结石清除率及手术并发症.结果 两组手术均取得成功,无一例中转开放手术.输尿管镜组与后腹腔镜组的平均手术时间为51.0±10.8 minVS 43.8±8.1 min(t=3.02,P=0.0037),住院时间为3.0±1.3 d VS 3.1t±0.9 d (t=-0.36,P=0.7217),一次手术结石清除率为87.5％ (28/32) VS 100％ (32/32),输尿管镜组术中4例发生结石上移,术后配合ESWL清除结石.两组术后随访3个月以上,未见输尿管狭窄等并发症.结论 对于单侧输尿管上段结石,后腹腔镜输尿管切开取石术较输尿管镜碎石取石术一次手术结石清除率高,手术时间短,是一种安全、有效的方法.     

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.     

预示输尿管镜碎石手术上镜失败的临床因素分析

目的探讨输尿管镜碎石手术时因管腔细小造成输尿管镜上镜失败的相关临床因素。 方法回顾性分析我院2018年5月至2019年8月同一术者行输尿管镜碎石手术病例的临床资料，手术使用8/9.8 F输尿管硬镜，根据上镜成功或失败分组并进行相关资料的比较。 结果输尿管镜碎石手术患者共102例，其中上镜成功91例，失败11例，一次上镜失败率10.8%。两组在年龄、性别、身高、体重及体质量指数（BMI）、糖尿病发生率、术前ESWL史、自然排石史和输尿管镜操作史、结石纵径等方面比较差异均无统计学意义（P>0.05）。成功组结石横径显著大于失败组[（7.7±1.4）mm vs （5.8±1.1）mm，P<0.001]；上段结石患者失败率最高，为30%（9/30），显著高于中段3.7%（1/27）和下段2.2%（1/45） （P<0.001）；而上段结石患者中，失败组横径显著小于成功组[（5.9±1.2）mm vs （8.4±1.4）mm，P<0.001]。进一步行多因素逐步Logistic回归分析表明结石横径（P=0.027）和结石位置（P=0.042）是上镜失败的危险因素。 结论结石位于输尿管上段且结石横径较小预示管腔细小导致输尿管镜上镜失败的可能性大，术前应充分预估。     

输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石

目的：探讨输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石的疗效及其安全性。方法：2005年1月～2009年12月应用NTrap网篮输尿管镜下配合钬激光碎石术治疗输尿管结石206例,并对临床资料进行分析。结果：一次手术碎石成功195例,成功率94．7％（195／206）;10例在碎石过程中结石被冲入肾盏内形成结石残留,术后行ESWL治愈;1例双侧输尿管结石因输尿管狭窄中转开放手术取出结石并切除狭窄段输尿管。所有患者术后无严重并发症发生。结论：输尿管镜下NTrap网篮配合钬激光碎石可以有效防止碎石逆行移位,避免术后结石残留于肾盏,是一种安全、有效的工具。     

输尿管封堵取石导管在输尿管上段结石中的应用

目的探讨输尿管封堵取石导管联合钬激光碎石治疗输尿管上段结石的临床效果。 方法回顾性分析2016年4月至2017年3月在我院诊断为输尿管上段结石并行输尿管镜碎石术患者病例资料,导管组采用输尿管封堵取石导管联合钬激光碎石,对照组仅采用钬激光碎石,比较两组手术效果,并采用Logistic回归分析可造成结石残留率增高的因素。 结果两组患者术前情况差异无统计学意义,全部患者均完成碎石,其中导管组70例患者中58例一期成功碎石取石,12例患者术后有结石残留,有2例需体外碎石。对照组51例患者中30例一期成功碎石取石,20例患者术后有结石残留,有13例需体外碎石。两组术中术后均无严重并发症发生。结石大小、肾积水程度、输尿管扩张程度可影响碎石成功率。 结论输尿管封堵取石导管联合钬激光碎石是治疗输尿管上段结石安全有效的方法,能显著减少结石移位并提高碎石成功率,输尿管扩张程度是影响碎石成功率最主要因素。     

The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experiences

ObjectiveTo analyze the characteristics of ureteral stricture after ureteroscopic holmium laser lithotripsy and summarize our experience with the reconstructive strategies.MethodsThis study retrospectively reviewed 42 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy between December 2009 and December 2019. Patient demographics, laboratory data, imaging studies, perioperative variables, complications, and follow-up data were recorded. Surgical success was defined as relief of symptoms, improved/stabilized hydronephrosis, and stable renal function.ResultsThe upper, middle, and lower thirds of the ureter were affected in 27, 6, and 7 cases, respectively. Multiple ureteral strictures were found in 2 patients. The median length of the stricture was 3.5 cm (range 1–30 cm). In the upper ureteral strictures, lingual mucosal ureteroplasty (8/27, 29.6%) is the most commonly used treatment method for stricture longer than 3 cm but shorter than 6 cm, followed by appendiceal onlay ureteroplasty (5/27, 18.5%). Four lower ureteral strictures ranging from 3 to 8 cm were repaired with Boari flap. Reconstructive strategies of the middle ureteral strictures included Boari flap, appendiceal onlay ureteroplasty and ureteroureterostomy. Patients with the length of the stricture longer than 8 cm or multiple strictures underwent ileal ureter replacement. The median follow-up was 27.3 ± 17.2 months. The overall success rate was 97.6%.ConclusionUpper ureter is more vulnerable in ureteroscopic holmium laser lithotripsy. Sufficient follow-up and appropriate examination are necessary for diagnosis. Different treatment strategies need to be flexibly selected according to the location and length of the injury.