顺行与逆行输尿管镜下钬激光碎石术治疗合并感染的输尿管结石比较

目的 比较顺行经皮肾输尿管镜下与逆行经尿道输尿管镜下钬激光碎石取石术治疗合并感染的输尿管结石过程中手术时间、并发症、血清C反应蛋白浓度的改变等,为选择手术方式提供依据.方法 选择2008年4月至2010年10月在我院住院手术治疗的合并感染的输尿管结石患者102例,根据手术适应证分组,45例接受经皮肾输尿管镜取石术,57例接受经尿道输尿管镜取石术.术前、术中、术后检查记录手术时间、住院时间、并发症等指标,并分别于术前第1天,手术后24h测定血清C反应蛋白含量,比较两组间有无差异.结果 两组患者在性别、年龄、结石大小、病程长短等方面无明显差异(P＞0.05);顺行经皮肾微造瘘组的手术成功率、一期结石清除率高于逆行手术组(P＜0.05),并发症发生率两组间比较差异无统计学意义(P＞0.05),PCNL组平均手术时间及住院时间较长(P＜0.05).术前两组血清CRP含量无差异,术后24h有明显差异(P＜0.05),顺行组较逆行组明显减少.结论 对于合并感染的输尿管结石的治疗,经皮肾输尿管镜取石术对机体全身的影响低于经尿道输尿管镜取石术,治疗方式的选择主要取决于结石的部位,对于第四腰椎平面以上的输尿管上段结石PCNL术更安全有效.     

经尿道输尿管镜和微造瘘经皮肾镜治疗输尿管嵌顿结石

目的总结采用经尿道输尿管镜碎石术（URL）和微造瘘经皮肾穿刺取石术（MPCNL）治疗嵌顿性输尿管结石的经验。方法采用输尿管镜观察72例输尿管结石嵌顿情况，并给予及时处理。结果URL和MPCNL处理成功70例，成功率97.7%，并发输尿管息肉40例，输尿管狭窄5例，均同期处理。5例结石被冲入肾盂内行体外冲击波碎石（ESWL）治疗。10例输尿管上段嵌顿结石行微造瘘经皮肾穿刺取石术（MPCNL）。结论输尿管结石嵌顿因素主要为输尿管息肉、狭窄或结石不规则。采用URL和MPCNL技术处理嵌顿结石疗效满意，安全性高，侵袭性小，是处理输尿管嵌顿结石的一种好方法。     

经皮肾与经尿道输尿管镜术治疗输尿管上段嵌顿结石的疗效比较

目的比较微创经皮肾输尿管镜取石术（mini-PCNL）与经尿道输尿管镜取石术（URL）治疗输尿管上段嵌顿性结石的疗效。方法182例输尿管上段嵌顿性结石患者中95例采用mini-PCNL治疗，87例采用URL治疗，共24例接受ESWL辅助治疗。结果mini—PCNL组术后1个月清石率100%，URL组术后1个月清石率92％。结论与URL相比，mini-PCNL技术处理输尿管上段嵌顿性结石更为优越。     

输尿管上段嵌顿结石经皮肾输尿管碎石术疗效观察

目的探讨输尿管上段嵌顿结石经皮肾输尿管碎石术(MPCNL)的疗效。方法将50例输尿管上段嵌顿结石的患者随机分为对照组和观察组,每组25例。对照组实施经尿道输尿管镜碎石术(URL),观察组实施MPCNL。比较2组治疗效果和并发症发生情况。结果观察组手术时间、住院时间均少于对照组,观察组术后3 d和术后1个月结石清除率均显著高于对照组,2组比较,差异有统计学意义(P﹤0.05)。2组术中出血量及并发症发生率比较,差异无统计学意义(P﹥0.05)。结论与URL比较。MPCNL治疗输尿管上段嵌顿结石,结石清除率高,并发症无明显增加,疗效肯定。     

超声引导下逆行经尿道输尿管镜与顺行经皮输尿管镜治疗输尿管上段结石的比较研究

目的 研究超声引导下逆行经尿道输尿管镜与顺行经皮输尿管镜治疗输尿管上段结石的疗效。方法 将2012年8月至2013年8月期间,在本院接受顺行经皮输尿管镜治疗的输尿管上段结石患者50例纳入研究的观察组,进行前瞻性研究,将2011年8月至2012年7月期间,在本院接受超声引导下逆行经尿道输尿管镜治疗的对照组,进行回顾性研究。比较两组患者的碎石成功率、手术情况和应激程度。结果观察组患者的碎石成功率(96%)高于对照组(χ2=8.306、P<0.05);手术时间(62.3±10.8)分钟、住院总时间(8.6±2.5)天长于对照组,CRP(34.8±6.4)mg/L、肾上腺素(82.3±10.1)ng/ml、去甲肾上腺素(108.2±14.2)ng/ml、肾素(2.1±0.3)pg/ml、血管紧张素Ⅱ(24.3±5.2)pg/ml水平均低于对照组。结论 顺行经皮输尿管镜治疗能够提高碎石成功率,减小手术创伤和应激,促进术后恢复,是治疗输尿管上段结石的理想方法。     

输尿管镜与微创经皮肾镜治疗输尿管上段嵌顿性结石的比较

目的对比EMS碎石清石系统行输尿管镜与微创经皮肾镜治疗输尿管上段嵌顿性结石的疗效。 方法回顾性分析2014年1月至2016年12月中山大学附属第五医院收治的嵌顿性输尿管上段结石患者96例的临床资料,输尿管镜组与经皮肾镜组各48例。两组均采用EMS碎石清石系统,输尿管镜组使用输尿管硬镜取石术,经皮肾镜组使用微创经皮肾镜取石术。比较两组患者手术时间、术后住院时间、结石清除率及术后并发症等相关临床指标。 结果输尿管镜组手术时间和住院时间分别为（54±8）min和（3.6±0.7）d,经皮肾镜组分别为（59±9）min和（5.6±0.8）d,两组相比差异均有统计学意义（P<0.05）;经皮肾镜组一次碎石成功率为100.00%,高于输尿管镜组的75.00%,差异有统计学意义（P<0.05）;术后3 d清石率、1个月清石率输尿管镜组分别为47.92%和79.17%,经皮肾镜组分别为100%和100%,两组相比差异有统计学意义（P<0.05）。术中输尿管穿孔、输血率及术后发热、血尿等并发症发生率两组差异无统计学意义（P>0.05）。 结论对于嵌顿性输尿管上段结石,EMS碎石清石系统下行微创经皮肾镜比输尿管镜具有更高的结石清除率及手术成功率,是此类结石的有效治疗方法。     

微创经皮输尿管镜与逆行输尿管镜治疗梗阻性输尿管上段结石的前瞻性随机对照研究

目的比较微创经皮输尿管镜与逆行输尿管镜治疗梗阻性输尿管上段结石的疗效和安全性。方法 91例梗阻性输尿管上段结石患者,随机分为两组,分别行微创经皮输尿管镜(44例)和逆行输尿管镜(47例)结合钬激光碎石治疗。结石横径均1cm。纳入研究的梗阻性输尿管上段结石定义为结石位于肾盂输尿管连接部至第四腰椎横突下缘水平之间且静脉肾盂造影片中造影剂不能到达结石以下部位。分析比较术后次日和术后1个月的结石清除率、手术时间、住院时间、手术失败率以及术中、术后并发症。结果微创经皮输尿管镜组术后次日和术后1月的结石清除率均明显高于逆行输尿管镜组,分别为(95.3%和79.5%,P=0.027)以及(100%和86.4%,P=0.026)。微创经皮输尿管镜组平均手术时间[(75.4±11.8)和(30.6±7.8)分钟,P0.001]、平均住院时间[(6.3±0.5)和(2.1±0.4)天,P0.001]均明显高于逆行输尿管镜组。手术失败率和术中、术后并发症两组无统计学差异。结论对于结石横径1cm的梗阻性输尿管上段结石,微创经皮尿管镜与逆行输尿管镜比较,前者更易取净结石,但手术时间和住院时间较长。     

钬激光经皮输尿管镜治疗输尿管上段结石

目的:探讨钬激光经皮输尿管镜治疗上段输尿管结石的疗效和安全性.方法:应用钬激光经皮输尿管镜技术治疗输尿管上段嵌顿结石24例,结石平均直径1.8 cm,大部分嵌顿于上段输尿管临近肾盂处.记录手术耗时,结石取净率和术后并发症.结果:手术时间平均42 min,一次性取净率92%,二次取净率100%,术后血尿4例(16.7%,4/24),发热(38℃以上)7例(29.2%,7/24),腹胀2例(8.3%,2/24),无其他并发症.结论:钬激光经皮输尿管镜治疗输尿管上段嵌顿结石,疗效确切,极大的减少了结石残留概率,是治疗输尿管上段结石安全、有效的方法.     

微创经皮肾镜取石术治疗输尿管上段结石临床分析

目的评价微创经皮肾镜取石术治疗输尿管上段结石的有效性和安全性。方法2002年2月～2007年10月,应用微创经皮肾造瘘,输尿管镜直视下气压弹道或钬激光碎石治疗168例175侧输尿管上段结石。结果168例均为Ⅰ期碎石、取石,手术时间35～65min,平均45min,结石清除率为100%。术后住院时间4～9d,平均6d。术后发热12例,未出现严重并发症。132例随访3～24个月,平均14个月,无输尿管狭窄及结石残留、复发。结论微创经皮肾镜取石术治疗输尿管上段结石损伤小,并发症少,结石清除率高,尤其适用于结石较大、肉芽包裹嵌顿性输尿管上段结石。     

微创经皮肾镜取石和经尿道输尿管镜碎石治疗输尿管上段嵌顿性结石的疗效比较

目的比较微创经皮肾镜穿刺取石术（minimally invasive precutaneous nephrolithotomy,MPCNL）与经尿道输尿管镜碎石术（transurethral ureteroscopic lithotripsy,URL）治疗输尿管上段嵌顿结石的疗效。方法从2008年03月～2012年03月,70例单侧嵌顿性输尿管上段结石的患者,35例采用MPCNL治疗,35例采用URL治疗,对2组患者的结石清除率、手术时间、术中出血、住院时间以及手术并发症等进行分析比较。结果 MPCNL组术后3d结石清除率为97.14%（34/35）,术后1个月结石清除率为100%（35/35）;URL组术后3d结石清除率为25.71%（9/35）,术后1个月的结石清除率为82.86%（29/35）,均显著低于MPCNL组（P〈0.05）;在手术时间、术中出血、住院时间、术后发热（T〉38.5℃）的发生率等方面,MPCNL组和URL组在统计学上无显著性差异（P〉0.05）。结论 MPCNL治疗输尿管上段嵌顿性结石相较URL,其结石清除率高,且具有安全、有效、术后并发症少等的优点,可作为输尿管上段嵌顿性结石的首选治疗方法。     

微创经皮输尿管镜与逆行输尿管镜治疗嵌顿性输尿管上段结石的疗效比较

目的：比较微创经皮输尿管镜（MPCNI。）与逆行输尿管镜（URI,）治疗嵌顿性输尿管上段结石的疗效。方法：回顾分析92例临床资料,比较两种方法的碎石成功率、手术时间、术后恢复时间、术后3天、术后1个月的结石清除率及术中术后并发症。结果：MPCNI。组碎石成功率、术后3天和术后1个月的结石清除率均明显高于URI。组,分别为（97．8％vs．80．9％;P—0．009）、（95．5％VS．81．6％;P—0．045）和（100％VS．89．5％;P—0．027）。MPCNI。组平均手术时间、术后平均住院时间和平均住院费用均明显高于URI。组。分别为（74．9±18．5）VS．（33．1±15．0）min（P〈0．001）,（7．2±1．9）VS．（3．9±1．3）d（P〈0．001）和（10533±l 123．2）VS．（5587．7±560．6）元（P〈0．001）,手术失败率和术中、术后并发症两组差异无统计学意义。URI．组中6例辅助ES-WL,治疗,无严重许发症,1个月后结石清除率提高至92．9％。MPCNI。的碎石率和清石率优于URI．（P〈0．05）。结论：MPCNI。与URI。比较,前者更易取净结石．术后近期并发症少．疗效更确切,但手术时间和住院时间较长．仲院费用转昔．URl。治疗效果较尊,佴联合ESWI。可槔高疗效。     

Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy

PURPOSE: We compared the safety and efficacy of percutaneous antegrade ureterolithotripsy with retrograde ureterolithotripsy for large impacted proximal ureter stones in a prospective randomized manner. MATERIALS AND METHODS: A total of 91 patients with large impacted proximal ureteral stones, defined as stones >1 cm in size located between the ureteropelvic junction and the lower border of the fourth lumbar vertebra, were prospectively randomized for antegrade (44) or retrograde (47) ureterolithotripsy. Failure of the procedure (conversion to an open procedure), intraoperative and postoperative morbidity, operative time, hospital stay, stone clearance at discharge home, and follow-up were analyzed in each group. RESULTS: The main complications were bleeding (2.3%; 1 of 43) for the antegrade procedure and ureteral injury (2.3%; 1 of 44) for the retrograde procedure. Percutaneous antegrade ureterolithotripsy was associated with longer operative times (75.4+/-11.8 v 30.6+/-7.8 minutes; P<0.001), longer hospital stay (6.3+/-0.5 v 2.1+/-0.4 days; P<0.001), and a longer interval to return to normal activities (7.8+/-0.7 v 2.7+/-0.6 days; P<0.001). Nevertheless, the percutaneous antegrade procedure had a higher stone-free rate both at discharge home (95.3% v 79.5%; P=0.027), and 1 month post-procedure (100% v 86.4%; P=0.026). CONCLUSIONS: Percutaneous antegrade ureterolithotripsy is a valuable treatment modality for impacted proximal ureteral calculi larger than 1 cm, and achieves higher stone-free rates than those of retrograde ureteroscopy with holmium:YAG laser lithotripsy. The drawbacks of the antegrade procedure are longer operative time and hospital stay.     

Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi?

OBJECTIVE: This study was planned to compare the risks and advantages of antegrade and retrograde ureteroscopy for impacted large upper ureteral calculi. PATIENTS AND METHODS: From September 1996 to February 1998, ureteroscopy was offered to 43 patients. Of these, retrograde ureteroscopy was done in 20 patients, while antegrade ureteroscopy was performed in 23 patients. All these patients were followed up to evaluate the immediate and long-term success of the procedure. The incidence and nature of complications were also noted. RESULTS: During retrograde ureteroscopy, complete stone clearance was achieved in 11 patients (55%), while pushback of the whole or fragmented calculus was seen in the rest. These patients with residual calculi were later treated by extracorporeal shockwave lithotripsy (SWL). The stone-free rate at the end of 3 months was 85%. Three patients developed minor ureteroscopy-related complications. Complete stone clearance was achieved in all patients with antegrade ureteroscopy. No intraoperative or postoperative complications were encountered. CONCLUSION: In this series, antegrade ureteroscopy was found to be a safe and effective option for impacted upper ureteral calculi and assured better results than retrograde ureteroscopy.     

Management of impacted upper ureteric calculi: results of lithotripsy and percutaneous litholapaxy.

Despite the availability of lithotripsy and endourology, clear guidelines on the management of impacted upper ureteric calculi are lacking. In this study, 51 upper ureteric calculi treated with in situ extracorporeal shock wave lithotripsy (ESWL) were classified according to the degree of impaction as indicated by proximal back pressure changes. Patients with mild proximal hydronephrosis (or none at all) had a success rate of 93% but only 35% of those in the impacted group (moderate to severe hydronephrosis) had a successful outcome. A percutaneous antegrade approach to 29 impacted upper ureteric calculi resulted in total clearance in 23 cases; 4 other patients were rendered stone-free following additional procedures, an overall success rate of 93%. The only complication was a ureteric stricture in 1 patient. We recommend the percutaneous approach in the management of impacted upper ureteric calculi.     

The impact of extracorporeal piezoelectric lithotripsy on the management of ureteric calculi: an audit

The presentation and management of 153 patients with ureteric calculi requiring active treatment over a 12-month period were reviewed; 74% of patients had primary ureteric calculi and 26% had ureteric calculi composed of fragments resulting from extracorporeal piezoelectric shockwave lithotripsy (EPL) to renal calculi; 32 patients (21%) had more than 1 calculus or a steinstrasse. The primary procedures included were in situ EPL (n = 54), push-bang (44), retrograde ureteroscopy (40), Dormia basket extraction (6), push-pull (1), antegrade ureteroscopy (1) and combinations of these (7). The success of the primary procedure could not be predicted from stone size, site or duration in the ureter, but upper tract dilatation was significantly less (p less than 0.01) in the successful group. The overall success rate for complete stone extraction was 97%, but 54 patients (35%) required more than 1 procedure to achieve this. In situ EPL and push-bang, as either primary or secondary procedures, were successful in treating 79 patients (52%); 2 patients required ureterolithotomy (1.3%). The overall complication rate was 18%. Since EPL is only successful in treating approximately half of ureteric calculi, a range of other treatments should be available to maintain a low rate of open surgery.     

输尿管上段嵌顿性结石的三种微创手术疗效分析

目的比较经尿道输尿管镜碎石取石术（URL）、微创经皮肾镜碎石取石术（MPCNL）和后腹腔镜输尿管切开取石（RLU）三种微创手术处理输尿管上段嵌顿性结石疗效。 方法回顾性分析2013年12月至2017年12月在我院治疗的输尿管上段嵌顿性结石69例,其中URL组23例,MPCNL组26例,RLU组20例。 结果三组患者年龄、结石位置、结石大小、肾积水比较差异无统计学意义（P>0.05）。三组手术时间、术后住院日分别为URL组（34±11）min、（3.2±2.5）d,MPCNL组（59±12）min、（5.5±2.2）d,RLU组（122±25）min、（8.3±2.1）d,差异均有统计学意义（P<0.05）;三组手术成功率、1个月净石率分别为,URL组82.6%（19/23）、78.3%（18/23）,MPCNL组100%（26/26）、100%（26/26）,RLU组95%（19/20）、100%（20/20）,URL与其余两组对比差异均有统计学意义（P<0.05）。 结论MPCNL具有手术时间短、成功率高、净石率高特点,治疗输尿管上段嵌顿性结石效果确切,若合并肾结石可作为首选治疗;URL不推荐作为输尿管上段结石首先治疗;RLU可作为输尿管上段嵌顿结石可选择性治疗。     

Combined percutaneous and retrograde approach to staghorn calculi with application of the ureteral access sheath to facilitate percutaneous nephrolithotomy

PURPOSE: We describe our technique and clinical experience with application of the ureteral access sheath for single access ablation of staghorn and partial staghorn calculi. MATERIALS AND METHODS: We retrospectively reviewed our experience with 9 patients who underwent percutaneous nephrolithotomy for staghorn (6) or partial staghorn (3) renal calculi using a combined antegrade and retrograde approach. Patient data, operative parameters, efficacy of stone ablation and convalescence parameters were reviewed. RESULTS: Mean operative time for the primary procedure was 3.1 hours with a mean estimated blood loss of 290 ml. Postoperatively, the mean analgesic requirement was 33.2 mg. MSO(4) equivalents. Hospital stay was 3.2 days. There were no major and 4 minor (44%) complications. No patient required transfusion. Complete stone clearance was achieved in 7 of the 9 cases (78%) using a single percutaneous nephrostomy tract. CONCLUSIONS: Our preliminary clinical experience using the ureteral access sheath during percutaneous nephrolithotomy for simultaneous antegrade and retrograde stone treatment has been favorable. A large renal stone burden can be successfully managed with a single percutaneous access and limited blood loss.     

Impacted upper-ureteral calculi >1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach?

PURPOSE: To compare blind access and totally tubeless percutaneous antegrade removal and pneumatic transurethral ureterolithotripsy for the management of impacted upper-ureteral calculi >1 cm. Patients and METHODS: Seventy patients (41 male, 29 female) with impacted upper-ureteral calculi >1 cm were selected in randomized order for pneumatic transurethral ureterolithotripsy (35 patients) or blind access and totally tubeless percutaneous nephrolithotomy (PCNL) (35 patients). Ultrasonography and intravenous urography were performed for all patients before surgery. After operation, plain films and ultrasonography were done. RESULTS: In the PCNL group, blind access was achieved from the lumbar notch area in all 35 patients, but in 3 patients, the exposure was not optimal for approaching the ureteropelvic junction (UPJ). So we injected contrast material into the collecting system, and, under fluoroscopic control, another access was achieved. In 33 patients (94.3%), intact removal of the stones was performed. In the other two patients, we fragmented the stones with the Swiss Lithoclast by an antegrade approach. The success rate thus was 100%. The mean operative time was 38 minutes (range 25-48 minutes). In the transurethral lithotripsy group, 12 stones (34.2%) migrated upward to the pelvis of kidney, and 5 stones (14.2%) fragmented incompletely. In these cases, a double- J stent was inserted, and SWL was performed. In follow-up, plain films and ultrasonography showed complete clearance in these patients. Eighteen calculi (51.4%) fragmented completely with the Lithoclast. The mean operative time in this group was 34 minutes (range 20-58 minutes). CONCLUSION: In the presence of moderate to severe hydronephrosis, blind access and totally tubeless PCNL is an effective option for large, impacted upper-ureteral calculi. Flexible ureteroscopy with laser lithotripsy is expensive and not readily available. Pneumatic transurethral ureterolithotripsy has a back-pressure effect and pushes back the calculi to the kidney. Thus, this procedure does not have satisfactory results in the management of these calculi.     

Using retroperitoneal laparoscopic ureterolithotomy in the treatment of impacted upper ureteric calculi

BackgroundThe ideal treatment for upper ureteric calculi is still debatable, particularly for patients with large, impacted ureteric calculi. Retroperitoneal laparoscopic ureterolithotomy (RLU) may be a worthwhile alternative to open surgery. In this study, we retrospectively evaluated our clinical experience associated with RLU performed for impacted upper ureteric calculi (>1.5 cm) help urologists in clinical practice and provide a reference for clinical work.MethodsA total of 64 cases (38 males; 26 females) with impacted upper ureteric calculi between April 2018 and January 2020 were analyzed retrospectively. The basic information of the included research subjects are as follows: The mean age was 50.8±25.4 years. The largest stone diameter was 1.8±0.3 cm. The mean stone retention time was 42±11 days. The mean degree of hydronephrosis was 2.8±1.2 cm.ResultsThe mean operative time was 85.4±18.3 minutes. The mean hospital duration was 7.5±1.8 days. The stone-free rate was 98.4%. Two patients required additional intervention. Post-operative fever developed in 3 patients. The decrease in hemoglobin levels was 7.8±3.6 g/L. The increase in procalcitonin (PCT) level was 3.7±1.8 ng/mL. No major complications, for example, sepsis, bleeding, bowel injury, or cardiopulmonary morbidities, were reported.ConclusionsRLU should be regarded as an excellent first line treatment modality for impacted upper ureteric calculi (>1.5 cm) owing to the high success rate, low complication rate, and the short length of operative time and hospital duration.