移植肾上尿路结石的腔内治疗

目的评估内镜治疗肾移植术后尿路结石的疗效。方法 5例肾移植并发上尿路结石患者接受了内镜手术治疗。其中肾结石2例,输尿管结石3例（其中输尿管膀胱吻合口狭窄并结石1例,金属支架结石2例）。结石最大直径11~52mm,发病时间为接受肾移植术后10个月~6年。结果 2例肾结石及1例金属支架结石患者接受钬激光经皮肾镜碎石取石术成功,2例输尿管结石行输尿管镜取石成功。无一例患者出现严重并发症。结论微创内镜手术在治疗移植肾术后并发尿路结石具有良好的效果。     

移植肾上尿路结石治疗方法的比较

目的比较不同的治疗方法对肾移植术后上尿路结石的疗效。方法收集我院1996至2002年间肾移植术后发生移植肾输尿管肾盂结石的患15例，其中肾结石4例，输尿管结石11例；体外震波碎石(ESWL)3例，输尿管镜取石7例，开放手术5例。结果5例开放手术术后均发生切口感染、尿外渗，其中2例有一过性肾功能不全．2例术后发生输尿管狭窄。3例体外震波碎石后都出现不同程度肾功能受损，严重血尿，2例碎石后产生石街。输尿管肾镜取石顺利完成，几乎无任何并发症出现。结论在严格掌握适应证的情况下，移植肾上尿路结石的治疗应首选经输尿管肾镜取石。     

ESWL与腔内技术联合处理复杂性上尿路结石(附编者按)

目的　探讨复杂性上尿路结石的治疗方法。　方法　对近期 138例复杂性上尿路结石患者 ,采用体外冲击波碎石 (ESWL)与输尿管镜下气压弹道碎石 ,经皮肾微穿刺造瘘碎石、取石等腔内技术联合治疗。其中复杂性输尿管结石 110例 ,复杂性肾结石 2 8例 ,均有不同程度肾积水。对输尿管结石先行ESWL ,2 4h内再行输尿管镜下气压弹道碎石 ;对肾结石及输尿管镜碎石困难的输尿管上段结石 ,先一期行经皮肾微穿刺造瘘术 ,5～ 7d后行ESWL ,2 4h内再经肾造瘘通道行输尿管镜下气压弹道碎石、取石。　结果　结石总排净率为 97.1% (134/138) ,其中输尿管结石排净率为10 0 .0 % (110 /110 ) ,肾结石排净率为 85 .7% (2 4 /2 8)。无治疗失败病例。　结论　ESWL与腔内技术联合处理复杂性上尿路结石 ,降低了腔内手术难度 ,缩短了腔内操作时间 ,提高了结石排净率 ,患者创伤小 ,恢复快 ,并发症少 ,是治疗复杂性上尿路结石较理想的方法。     

移植肾输尿管结石的治疗(附11例报告)北大核心CSCD

目的总结移植肾输尿管结石的治疗经验。方法2013年1月~2021年5月我院对11例移植肾输尿管结石行输尿管(软)镜碎石、经皮肾镜取石(percutaneous nephrolithotomy,PCNL)或体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗。结果4例输尿管上段结石,1例行积极监测及外院ESWL治疗;1例行输尿管镜碎石(ureteroscopic lithotripsy,URL)失败,改行肾造瘘(二期PCNL);2例行输尿管软镜碎石。7例输尿管下段结石,1例行ESWL 1次;2例行URL;1例合并移植肾输尿管口狭窄及肾结石,狭窄扩张后行URL和PCNL治疗;3例URL失败,除1例选择积极监测后失访外,余2例分别行输尿管切开取石和膀胱切开输尿管镜碎石。除1例失访外,余10例随访19~104个月,中位数43个月,均无残留结石,人肾均存活。结论移植肾输尿管结石的治疗应个体化,尽可能保护移植肾功能,积极监测、ESWL、PCNL和开放手术应谨慎选择,首选治疗为创伤小、并发症少的逆行输尿管(软)镜碎石,如需开放手术可考虑膀胱切开输尿管(软)镜碎石。     

学龄前儿童尿路结石的腔内治疗

目的 评价学龄前儿童尿路结石腔内治疗的疗效与安全性.方法 2004年8月至2008年8月,28例学龄前尿路结石患儿接受腔内治疗,其中11例输尿管结石患儿接受输尿管镜取石术,17例肾结石患儿接受微创经皮肾镜取石术.结果 11例输尿管结石患儿中,5例一期输尿管镜取石术,6例一期输尿管置管被动扩张1～3周后二期8/9.8 Fr输尿管硬镜下取石成功;17例肾结石患儿均一期微创经皮肾镜取石术.结论 对有手术指征的学龄前儿童尿路结石,采用微创腔内治疗是安全可靠的.     

微创经皮肾取石术治疗独立肾结石

目的：探讨微创经皮肾取石术治疗孤立肾结石的临床疗效与手术技巧。方法：利用微创经皮肾取石术治疗孤立肾结石18例，14例患者行一期微创经皮肾取石．4例行经皮肾穿刺造瘘术，5～7天后行二期取石术。结果：结石清除15例（83．3％）。在结石残留的3例患者中，1例残留结石下移至输尿管下段，用输尿管镜将结行取出；余2例结石残留。肾内，未作进一步处理，本组患者术后肾功能基本恢复正常或好转。结论：微创经皮肾取石术治疗独立肾结石是一种安全、有效的方法。     

腔内钬激光治疗上尿路疾病101例报告

目的探讨腔内钬激光治疗上尿路疾病的疗效。方法输尿管狭窄及中下段输尿管结石经尿道置人输尿管镜应用钬激光治疗；上段输尿管结石及肾结石建立经皮肾取石通道，然后置入输尿管镜应用钬激光碎石。结果无输尿管穿孔、漏尿及感染等情况发生。23例输尿管狭窄中，6例狭窄段消失，10例较治疗前增宽；5例输尿管狭窄段无明显增宽；2例输尿管狭窄段无变化或较治疗前狭窄加重或肾积水，输尿管扩张无变化，患者仍有腰部胀痛及反复感染症状，转开放性手术，行输尿管狭窄段切除，端端吻合术后治愈。术后随访3～24个月，平均12个月，无再狭窄。40例中下段输尿管结石中，采用输尿管镜逆行碎石，33例结石粉碎成功，7例结石返回肾脏，经二期体外震波碎石治愈；术后随访3～18个月，平均15个月，无输尿管狭窄、再发结石。24例上段输尿管结石及14例肾结石中，采用经皮输尿管镜碎石术，一期结石取净36例，2例由于术中出血，视野不清，留置肾造瘘管1周后二期将结石取净；术后随访3～24个月，平均18个月，无结石残留、再发、输尿管狭窄等。结论腔内钬激光治疗上尿路疾病是安全、微创，疗效显著，并发症少，值得推广应用。     

微创经皮肾镜取石术治疗移植肾及输尿管结石

目的探讨微创经皮肾镜取石术（mini-PCNL）治疗移植肾及输尿管结石的效果及临床意义。方法采用mini-PCNL治疗6例移植肾及输尿管结石患者,其中2例合并输尿管吻合口狭窄,结石负荷0.8～2.5cm。结果所有手术均成功,无严重并发症发生,5例患者结石完全清除,肾积水及肾功能术后均明显改善。结论 mini-PCNL治疗移植肾及输尿管结石,安全有效,值得临床推广。     

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。     

上尿路结石治疗后再住院原因分析

目的探讨肾和输尿管结石治疗后再住院与首次治疗方法之间的关系。方法分析166例上尿路结石再住院患者的临床资料，首次治疗方法包括：体外冲击波碎石(ESWL)，手术取石、ESWL 手术取石，ESWL 输尿管镜取石及输尿管镜取石。对上述方法的疗效和再住院原因进行对比研究。结果ESWL治疗103例次，手术取石44例，输尿管镜取石18例，术中发现肾盂输尿管连接部梗阻13例，ESWL后碎石颗粒嵌入黏膜8例，输尿管息肉5例，本组患侧肾功能丧失9例。结论无论采用何种方法治疗上尿路结石，事前对病史及患侧肾功能应有充分了解。如有解剖及代谢异常者须做相应处理。对于较复杂的结石应采取综合治疗措施，最大限度地保护肾功能。     

Ex vivo ureteroscopic treatment of calculi in donor kidneys at renal transplantation

PURPOSE: We evaluated the safety and efficacy of ex vivo ureteroscopy (ExURS) as a means of rendering the donated kidney stone-free at live donor renal transplantation. MATERIALS AND METHODS: A total of 10 suitable kidney donors with small, unilateral nonobstructive calculi underwent live donor nephrectomy (8 open flank, 2 hand assisted transperitoneal). Immediately after cold perfusion, ExURS was performed in an iced saline solution. Access to the collecting system was via the ureteral stump. Calculi were either removed with endoscopic baskets and/or completely fragmented with Holmium laser lithotripsy. RESULTS: Access to the renal collecting system was technically successful in all cases. A total of 10 stones, ranging in largest diameter from 1 to 8 mm (average 5.2) were visualized. Of the kidneys 6 had solitary stones, 2 had 2 stones and 1 had no stone. Of 10 stones 9 were successfully removed and/or fragmented with an average procedure time of 6.5 minutes (range 3 to 28). Indwelling ureteral stents were placed at transplantation in 5 of 10 kidneys. There were no intra-operative or postoperative ureteral complications. At 1 month after transplant serum creatinine ranged from 0.9 to 2.7 mg/dl (average 1.5). At a mean followup of 33.2 months new stones have not formed in any recipients and at mean 36.4-month followup no new calculi have formed in the remaining kidney of any donors. CONCLUSIONS: ExURS is a technically feasible means of rendering a stone bearing kidney stone-free without compromising ureteral integrity or renal allograft function.     

Ureteroscopic management of urological complications after renal transplantation

OBJECTIVE: To determine the feasibility, safety and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. MATERIAL AND METHODS: We reviewed 1560 consecutive renal allografts performed between June 1989 and February 2002. A total of 28 patients (1.8%) had indications for an endoscopic procedure on the allograft ureter, as follows: obstructive ureteral calculi with a history of failed extracorporeal shock-wave lithotripsy, n=6; suspected ureteral stricture, n=3; upwardly migrated ureteral stents, n=9; and ureteral stricture at the ureteroneocystostomy site, n=10. Ureters were anastomosed to the bladder using the Leadbetter-Politano and Lich-Gregoire methods in six and 22 cases, respectively. Ureteroscopies were performed with a semi-rigid 9.8 F Wolf ureteroscope. RESULTS: Identification of the ureteral orifice and insertion of a guide-wire into it was successful in 19 cases (68%). If we exclude the 10 patients with ureteral stricture, ureteroscopy was successful in 13/18 cases (72%). Four ureteral calculi (67%) were removed with the ureteroscope. Seven out of nine migrated stents (78%) were retrieved. Four patients with ureteral stricture at the ureteroneocystostomy site (40%) underwent successful ureteral dilatation and double-J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications (one urinary leakage and one symptomatic urinary tract infection) occurred and were managed conservatively. CONCLUSIONS: Ureteral endoscopy is a safe and effective method for the management of urological complications after renal transplantation. This procedure can be considered the first choice, in preference to percutaneous and antegrade modalities.     

Feasibility and outcome of retrograde endoscopy in a post-prostatectomy population

PURPOSE: To determine the feasibility of retrograde endoscopy after radical retropubic prostatectomy (RRP) and its effects on post-prostatectomy continence. PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent RRP at our institution between 1999 and 2005, identifying those who subsequently required endoscopic instrumentation. Patient records were examined for the interval between procedures, method of endoscopy, and continence after endoscopy compared with baseline post-prostatectomy continence. RESULTS: Twenty-one patients were identified who required endoscopic instrumentation from 4 to 49 months after RRP. Of these, 13 patients underwent ureteroscopy for stones (N = 8) or stricture disease (N = 5). In 3 cases, a ureteral access sheath was used, and in 12 cases, a ureteral stent placed postoperatively. Review of the operative reports revealed no complications or difficulty with cannulation of the ureteral orifice(s) or sheath placement. Eight patients underwent rigid cystoscopy for hematuria, removal of a foreign body, or treatment of bladder stones (N = 2 each) or for stent placement and frequency (N = 1 each). The ureter could not be identified in one case of attempted stent placement for hydronephrosis because of a distal-ureteral stone. A follow-up intravenous urogram confirmed passage of the stone and resolution of the hydronephrosis. There were no other reported difficulties with rigid cystoscopy. There was no documented change or adverse outcome regarding continence after endoscopy. CONCLUSIONS: Post-prostatectomy retrograde endoscopy is feasible for the management of common urologic pathologies. Endoscopic instrumentation across the urethrovesical anastomosis did not have an adverse effect on urinary continence.     

微创手术治疗输尿管上段结石256例报告

目的：探讨输尿管上段结石的微创手术治疗方法。方法：回顾性分析输尿管镜、后腹腔镜以及经皮肾镜治疗输尿管上段结石患者256例的临床经验,其中接受输尿管镜取石术176例,后腹腔镜取石术45例,经皮肾镜取石术35例。结果：本组结石长径6～25mm。输尿管镜取石成功率为81．3％,失败原因主要为输尿管扭曲、狭窄或结石下方有息肉梗阻;腹腔镜和经皮肾镜手术均获成功。所有患者术中留置双J管,1～3个月后拔除,无严重并发症发生。结论：微创手术治疗输尿管上段结石安全有效。对于较小结石,可选择输尿管镜取石;若结石体积较大、靠近UPJ、并肾内结石或输尿管镜手术失败,腹腔镜或经皮肾镜可提高手术成功率,并减少术后结石残留。     

经皮肾镜一期治疗继发性上尿路狭窄合并肾结石

目的：探讨经皮肾镜一期治疗继发性上尿路狭窄合并肾结石的可行性与临床疗效。方法回顾分析我院2006年7月～2013年7月97例继发性上尿路狭窄合并肾结石的临床资料。建立F24标准经皮肾镜操作通道,超声联合气压弹道将结石击碎并吸出体外,应用自制电钩或钬激光直视下将狭窄段切开。放置F5双J管2枚内引流。结果93例一期手术成功,手术时间30～180 min,平均75 min。1例因输尿管管腔完全闭塞,改开放手术;2例穿刺出脓性尿液,肾镜下碎石取石后,放置肾造瘘,二期内切开术;1例碎石时间较长,改二期内切开术。93例一期手术成功者术后随访3个月～3年,平均12个月。治愈84例,有效6例,无效3例。结论经皮肾镜一期治疗继发性上尿路狭窄合并肾结石,临床效果较好,手术创伤较小,术后恢复好、快,安全,具有可重复性的优点。     

Use of a prototype 3F electrohydraulic electrode with ureteroscopy for treatment of ureteral calculous disease

A 3F electrohydraulic electrode was used with flexible ureteroscopy to treat upper urinary tract calculi in 18 patients. Of 21 procedures performed 10 involved retrograde passage of the ureteroscope and 11 consisted of antegrade procedures with percutaneous nephrostomy access. Complete fragmentation was achieved in 19 of the 21 procedures. In 1 patient bilateral renal caliceal diverticular calculi were treated with the electrohydraulic electrode used to open initially the diverticular orifice. Minor complications included retained stone fragments and small ureteral perforations. No serious complications resulted from the lithotripsy and no patient required an open operation. Flexible ureteroscopy, retrograde or antegrade, appears to offer access to upper tract stones not treated reliably with rigid ureteroscopy. Electrohydraulic lithotripsy with this small 3F probe appears to be a safe and effective means to treat upper urinary tract stones.     

Retrograde ureteroscopy in patients with orthotopic ileal neobladder urinary diversion

PURPOSE: We assess the feasibility, technique, complications and clinical outcomes of retrograde ureteroscopy in patients with orthotopic ileal neobladder. MATERIALS AND METHODS: We retrospectively reviewed our ureteroscopy experience to identify procedures performed in patients who had previously undergone cystectomy with orthotopic ileal neobladder urinary diversion. These procedures were reviewed and data collected regarding patient characteristics, indication for endoscopic evaluation, surgical technique, findings, complications and followup. RESULTS: Eight patients with neobladder diversion were taken for 9 sessions in the cystoscopy suite for attempted retrograde ureteroscopy on 13 renal units. The indication for ureteroscopy was an upper tract filling defect, positive cytology or calculi. The ureter and renal pelvis were successfully accessed and visualized in 10 of 13 renal units. The cause of failure in the 3 unsuccessful procedures was inability to access the ureteral orifice. Mean operative time +/- SD was 78 +/- 34 minutes. Urothelial abnormalities were identified in 4 patients, extrinsic compression in 2 and stones in 3. In 1 patient postoperative hematuria developed, which spontaneously resolved. Fluoroscopy was essential to identify the afferent limb of the reservoir, and a directional guide wire was helpful in engaging the ureteral orifice. CONCLUSIONS: Ureteroscopic evaluation and treatment of upper tract abnormalities are feasible and practical in most patients with orthotopic neobladder urinary diversion. Identification of the ureteral orifice is challenging but can be accomplished with a combination of endoscopic and fluoroscopic techniques. This procedure avoids the morbidity of percutaneous access, and complications are minimal.     

Primary endoscopic treatment of ureteric calculi. A review of 378 cases.

AIM OF THE STUDY: In the post-ESWL period, ureteroscopy represented the solution giving a second choice in the treatment of ureteral calculi in case of failure of extracorporeal lithotripsy. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy can be chosen as the first approach for the treatment of ureteral calculi. METHODS: Between January 1994 and September 1997, 378 patients underwent ureteroscopy and endoscopic lithotripsy for ureteral stones with a miniscope associated with either a pneumatic or electropneumatic lithotriptor. Three different miniscopes were used: Olympus (8 Fr), Wolf (7 Fr) and Circon Acmi (7.7 Fr). 238 patients were male and 140 were female. The stones were localized in the upper tract of the ureter in 62 cases (16.4%), 96 (25.3%) in the mid ureter and 220 (58. 3%) in the lower ureter. RESULTS: A complete stone fragmentation with spontaneous expulsion of the fragments occurred in 354 patients (93.6%). In 22 patients (5.8%) the stones were accidentally pushed up and successfully underwent ESWL. In 38 patients (10%) the fragments were completely removed by basket. A single J polyethylene catheter was placed in 21 (5.5%) and a JJ stent in 147 patients (38. 8%). The operative time ranged from 10 to 60 min, with an average time span of 32. In 22 cases (5.8%) an iterative ureteroscopy for stenosis or incomplete fragmentation was needed. Five cases (1.3%) of ureteral perforation were successfully treated by JJ stent, and only 1 case of ureteral avulsion (upper ureter) was treated by open surgery. In the attempt of overcoming an ureteral stenosis, we had 1 case (0.2%) of ureteral reimplantation. One patient (0.2%) underwent ureterolithotomy for an extremely narrow stenosis just before the ureteropelvic junction. No relevant complication was recorded in the postoperative period. Patients were dismissed after 1- 4 days (average 1.9). Up until now, no case of postoperative ureteral stricture has been observed, although we were not able to carry out a specific follow-up in all our patients. CONCLUSIONS: Ureteroscopy with miniscopes has a high success rate (93.6%) with low morbidity and can be given as a primary approach in the management of ureteral calculi. In the lumbar ureter (especially in women) this technique can represent a good alternative to ESWL in the treatment of obstructing stones (which need stenting) or when the patient asks for a 'one-shot' treatment.     

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.