输尿管肾镜术中套石篮取石的经验

我院自1999年1月至1995年7月,对233例输尿管结石病人应用输尿管肾镜套石篮取石。取石成功率为93％。术后发热1.7％,输尿管穿孔3.4％。开放手术率4.7％。总结了输尿管肾镜下套石篮取石的经验教训。讨论了应用本手术治疗输尿管结石的实用性。     

半硬质输尿管镜操作引起输尿管或肾实质穿通损伤的分析

目的提高对半硬质输尿管镜操作中的穿通性损伤发生的认识及预防能力。方法回顾性分析2004年9月至2008年10月间我科收治的半硬质输尿管镜操作所致泌尿系统损伤11例,其中输尿管穿孔4例,输尿管假道2例,结石穿出输尿管3例,肾实质穿通性损伤2例。结果输尿管损伤者中6例接受手术修补输尿管并留置双J管,3例输尿管假道或结石穿出者在输尿管镜下放置双J管。术后三至四周拔除双J管,均恢复良好。对肾实质穿孔者,1例采用手术引流,1例证实为肾结核而行患’肾切除并抗结核治疗而治愈。结论输尿管或肾实质穿孔是半硬质输尿管镜操作中的较重并发症。正确的病例选择、良好的手术视野和尽可能低的灌注压力有利于避免这些并发症的发生。     

Rigid ureteroscopy for ureteral stones: factors associated with intraoperative adverse events

PURPOSE: To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy. PATIENTS AND METHODS: We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables. RESULTS: Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications. CONCLUSIONS: Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.     

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.     

A stone developed within the dilated intravesical ureter following ureteroscopy

A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.     

Spontaneous perforation of the ureter: clinical presentation and endourologic management

BACKGROUND AND PURPOSE: Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. We report on five cases from three institutions and discuss the literature. PATIENTS AND METHODS: Five patients presented with renal colic and the imaging modalities used to assess them showed extravasation of urine. RESULTS: The cause of spontaneous perforation of the ureter was a ureteral stone in one case and was unknown in four cases. In all cases, a Double-J ureteral stent was inserted under fluoroscopy. Urinoma was percutaneously drained in only one patient. Repeat imaging showed normal renal function and morphology in all patients. CONCLUSION: Spontaneous perforation of the ureter should be suspected after renal colic. Endourologic treatment offers excellent results, even for the management of acute complications.     

Transurethral uretero-lithotripsy of ureteral stones in Osaka City University

During the 39 months since the introduction of transurethral lithotripsy (TUL) for the treatment of ureteral stones at our hospital in August 1985, TUL was performed a total of 200 times in 178 patients with ureteral stones. Among them, 111 patients had left ureteral stones and 65 had right ureteral stones, while 2 patients had ureteral stones in both sides. The stones were divided into upper ureteral stone (84 patients) and lower ureteral stone (94 patients) at above and below the iliac brim. 89% of the stones were less than 2 cm in diameter. Most of the patients were given lumbar anesthesia, and a guide wire was inserted into the ureter. The ureter was dilated with a ureteral bougie, and a 13F or 14F Storz ureteroscope was inserted. The stones were disintegrated by an ultrasound lithotripto and removed using forceps and a basket catheter. After the TUL procedure, a double J catheter was indwelled and removed within 5 days. The results were evaluated by DIP which was done 2 to 3 months after TUL. The success rate included residual stones less than 4 mm in diameter, as they could be spontaneously discharged. As a result, the success rate for upper ureteral stones was 53%, and it was higher for smaller stones. On the other hand, the success rate for lower ureteral stones was 85% and significantly higher. The main reasons for failure were the upper migration of the stones (60%) and inability to insert the ureteroscope up to the stone due to ureterostenosis and ureteral perforation (39%).(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Long-term experience with transurethral rigid ureteroscopy as a complementary method to extracorporeal shockwave lithotripsy.

Between May 1985 and September 1990, 291 ureteroscopies were performed either for primary or secondary stone therapy or for diagnostic purposes. Rigid ureteroscopes (12.5 or 9.5 French) were used without dilation of the ureteral orifice. 83% of the stones could be removed either by direct extraction or electrohydraulic or ultrasound lithotripsy. The highest failure rates (25.6%) occurred in stones located in the upper ureter, the lowest failure rate (9.6%) resulted from treatment of lower ureteral stones. 3.4% complications were observed such as perforation, leakage, stenosis and septicemia. After an average follow-up of 4.5 months, 1 in 70 patients revealed an ureteropelvic stricture which was treated with open surgery. The ureterorenoscopy represents an effective and low-risk primary and secondary method for treatment of ureteral stones in stone centers using extracorporeal lithotriptors which are exclusively equipped with ultrasound detection devices.     

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。     

Pneumatic lithotripsy for large ureteral stones: is it the first line treatment?

Objective To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones. Methods We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%) were treated primarily with PL and 115 (73.7%) were treated secondarily after unsuccessful extracorporeal shock wave lithotripsy (SWL). The mean stone diameter was 12.87 mm (range 10–20.5 mm). Results were evaluated 3 months after treatment by excretory urography and/or ultrasonography. Results The overall stone-free and fragmentation rates (FRs) were 85.2 and 92.3%, respectively. Corresponding values were 60 and 84% for upper ureteral stones, 79.5 and 89.7% for middle ureter stones and 94.5 and 95.6% for lower ureteral stones, respectively. The main complications were migration of a complete stone or of fragments (7.1%), urosepsis (4.5%) and ureteral perforation (1.3%). Conclusions Although SWL is generally accepted as the first treatment option for ureteral stones because of its non-invasive nature, PL with ureteroscopy seems to be a good alternative with the advantage of higher success rates and quick stone clearance. Especially when we take the importance of quick stone removal into account for larger ureteral stones, which are more likely to have obstruction, impaction, or infection, we believe that PL may be chosen as the first line treatment rather than SWL for stones larger than 10 mm.     

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.     

Stentless pediatric ureteroscopic holmium: YAG laser stone disintegration: is gravels retrieval an issue?

Purpose

To evaluate the safety and efficacy of stentless pediatric ureteroscopic holmium laser stone disintegration without gravels retrieval.

Patients and methods

From Feb 2007 to Feb 2010, 21 children (12 boys and 9 girls) with unilateral single stone ureter, with an average age of 8.5?years (range 4?C12?years), were treated with 6.9 Fr semirigid ureteroscope for a stone size ranged from 5 to 10?mm (mean 6.5?mm). All the stones were radioopaque, located in the upper ureter in 2 cases (9.5%), in the middle ureter in 5 cases (24%), and in the lower ureter in 14 cases (66.5%). Complete holmium laser stone disintegration was applied in all cases without gravels removal. No postoperative ureteral stent was inserted in any case.

Results

The stones were successfully approached and completely disintegrated in a single session in 20 cases (95.2%). All the procedures were done without ureteral orifice dilatation apart from 3 cases where another working guide wire was applied. No intraoperative complications were recorded in the form of mucosal injury, ureteral perforation, or urinary extravasation. There is no early postoperative complication in the form of urinary tract infection or colic apart from single case of hematuria which was successfully treated conservatively. Two weeks postoperatively, KUB (kidney, ureter, and bladder) films were completely free from any significant gravel (>3?mm) and US showed no hydronephrosis.

Conclusion

Stentless ureteroscopic holmium laser disintegration without gravels removal is a safe and effective method for pediatric ureteral stone less than 10?mm in diameter.     

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。     

Ureteroscopy: results and complications

The results and complications of 100 consecutive ureteroscopy studies are reported. Introduction through the orifice or the intramural ureter failed in 11 per cent of the patients and in 14 per cent the ureteroscope could not be advanced up to the level of the lesion. Ureteroscopy was successful in 75 per cent of the patients and stone extraction was successful in 69 per cent. Complications occurred in 9 patients: 4 had an uncomplicated urinary tract infection, 4 had a ureteral perforation and 1 presented with ureteral stenosis at the site of the extracted stone a few weeks later. At followup 1 to 3 months after ureteroscopy clinical examination, excretory urography and/or renography revealed no further late sequelae.     

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。     

上尿路结石的现代治疗方法的探讨(附5178例报告）

目的：探讨上尿路结石的现代治疗方法。方法：回顾性分析2001年2月8日～2002年12月31日收治的5178例上尿路结石患者的临床资料。结果：5178例中，采用体外冲击波碎石术(ESWL)治疗1826例，输尿管镜取石术(URL)2157例，微创经皮肾镜取石术(mini-PCNL)1131例，腹腔镜输尿管切开取石术8例和开放手术56例，分别占总数的35．3％、41．7％、21．8％、0．2％和1．0％。ESWL治疗中，1个月后结石排净率为83．0％，2个月后结石排净率为86．0％，3个月后为86．5％。术后有13例发生输尿管石街，采用URL或PCNL取净。URL对输尿管中、下段结石取净率为100％，上段为76％，术中无输尿管穿孔和撕脱并发症发生。mini—PCNL对肾盂和输尿管上段结石的取净率为100％，鹿角形结石为93％。术中未见肾盂大穿孔和。肾皮质撕裂。术后79例输血，输血率为1．5％。腹腔镜治疗8例全部成功，无并发症发生。结论：上尿路结石可用腔内技术和ESWL治疗，开放手术几乎可避免。     

Handling and prevention of complications in stone basketing

OBJECTIVE: To review the incidence, risk factors, and treatment options of intraoperative and postoperative complications of stone basketing in urology with emphasis on certain principles that must be upheld to prevent those complications. METHODS: A literature search was performed using the MEDLINE database on stone basketing between 1970 and 2005. RESULTS: Iatrogenic trauma due to retrieval of a stone is well known but the exact incidence is difficult to ascertain. Rarely, stone basketing can cause major trauma to the ureter, such as avulsion or intussusception, requiring open or laparoscopic intervention for ureteral continuity restoration. Mucosal abrasion, ureteral perforation, and stricture formation have also been described as complications of stone basketing. Occasionally, the engaged or broken basket can provoke anxiety even for experienced urologists. Factors that increase the risk of complications, strategies for repair, and techniques for prevention are discussed extensively. CONCLUSION: Infrequent, surgical misadventures during stone basketing can occur and must be treated appropriately. Careful attention to instrument selection and surgical techniques and awareness of risk factors and type and site of potential injury are essential to reduce these complications.     

输尿管镜术治疗输尿管结石(附157例报告)

目的 总结输尿管镜术治疗输尿管结石的疗效。方法 回顾性分析输尿管镜术治疗的157例输尿管结石患。结果 145例原位碎石成功，成功率为92．4％(其中上段61．9％，中段94．3％，下段98．8％)，经1—3个月的追踪复查，结石排净率100％。总的并发症发生率为8．3％，包括输尿管粘膜下损伤5例、输尿管穿孔3例、肾绞痛2例、继发性尿路感染3例。结论 输尿管镜术治疗输尿管结石损伤小、疗效好，是治疗输尿管中下段结石的首选方法。