Nephroscope Research Articles

Comparison of sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy in the treatment for senile upper ureteral incarcerated calculi

Objective To compare the efficacy of Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscopy in the treatment of incarcerated upper ureteral calculi in elderly patients. Methods From July 2016 to December 2017, 60 elderly patients with upper ureteral incarcerated calculi were selected from the department of urology of the Huaian hospital affiliated to Xuzhou medical university. According to the order of hospitalization, it was divided into the Sun's tip-flexible ureterorenoscopy (30 cases) and the minimally invasive percutaneous nephroscope (30 cases), respectively, with Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy. The one-time success rate, stone clearance rate, intraoperative bleeding volume, postoperative hospital stay, postoperative complications, postoperative comfort, pain and trauma index (TNF-a, IL-6 and CRP) were compared between the two groups. Results The two groups were successful in the first stage operation, and there was no significant difference between the two groups after 1 month of operation (P>0.05). The intraoperative bleeding volume, postoperative hospitalization time and incidence of postoperative complications in the Sun's tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05), and the pain scores in the Sun's tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05), while the comfort scores were significantly higher than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05). The levels of serum TNF-α, IL-6 and CRP in both groups increased 24 hours after operation, but decreased 72 hours later. The levels of TNF-α, IL-6 and CRP in percutaneous nephroscopy group were significantly higher than those in Sun's tip-flexible ureterorenoscopy group at different time points (P<0.05). Conclusions Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscope both have high lithotripsy efficiency in the treatment of incarcerated upper ureteral calculi in the elderly, but Sun's tip-flexible ureterorenoscopy has the advantages of small trauma, low complications and high comfort, which is worthy of wide clinical application. Key words: Ureteral Calculi; Ureteroscopy; Nephrostomy, Percutaneous

Comparison of the efficacy of flexible ureteroscope and percutaneous nephroscope in the treatment of stone remnants after percutaneous nephroscope

Objective To compare the efficacy of flexibl3e ureteroscope and percutaneous nephrolithotomy(PCNL) in the treatment of stone remnants after percutaneous nephrolithotomy. Methods From October 2012 to September 2018, 68 cases of stone remnants after percutaneous nephrolithotomy were treated by flexible ureteroscopy (flexible ureteroscope group) and 67 cases of stone remnants were treated by PCNL (second-stage PCNL group). Results The total stone removal rate was 85.29% (58/68) at 4 weeks after operation in the flexible ureteroscopy group, and 80.60% (54/67) in the second-stage PCNL group.The operation time of patients in the flexible ureteroscopy group was longer than that in the second-stage PCNL group, and the intraoperative blood loss was less than that in the PCNL group(P<0.05). The total stone removal rate of renal upper and middle calculi and multiple stone ureteroscope was higher than that of the second stage PCNL group, and the total stone removal rate of the second stage PCNL group was lower than that of the second stage PCNL group(P<0.05). Conclusions Flexible ureteroscope is a safe and reliable method for the treatment of upper and middle calices and multiple stone remnants. The second stage PCNL for the treatment of renal lower calculi stone has the advantages of complete stone removal and short operative time, especially for large stone remnants, which is still the main treatment method at present. Key words: Nephrostomy, Percutaneous; Ureteroscopy

Effect of perioperative predictive care on children with complicated renal calculi undergoing percutaneous nephroscopy

Objective To explore the effect of perioperative foreseeable nursing on children with complicated renal calculi by percutaneous nephrolithotomy. Methods A total of 68 cases of children with complicated kidney stones admitted to this hospital from October 2015 to October 2017 were selected.According to the random number table method, the patients were randomly divided into observation group and control group, 34 cases of each group.The control group adopted traditional nursing, while the observation group adopted the method of foreseeable nursing.The postoperative complications of the two groups were observed and recorded, and the patients and their families were investigated and recorded in detail before discharge.For younger children, the opinions of family members were taken as reference. Results The infection, postoperative bleeding, peripheral organ injury, double J tube displacement, urinary extravasation, and water and electrolyte disorder in the observation group were significantly lower than those in the control group, and the differences between the two groups were statistically significant(P<0.05). The nursing satisfaction of children and their families in the observation group was significantly higher than those in the control group, and the differences between the two groups were statistically significant(P<0.05). Conclusion Perioperative predictive care can significantly improve the prognosis of children with complicated renal stones undergoing percutaneous nephroscopy, on the one hand, reduce the incidence of postoperative complications, reduce their pain, and on the other hand, improve the nursing satisfaction of children. Key words: Predictive care; Complex kidney stones; Percutaneous nephrolithotomy; Complications; Degree of satisfaction

Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi

Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy(PCNL) with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi. Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation, CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix, the neck of the calyx and the body surface were regarded as the puncture point on the body surface, and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi, two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy. Results Percutaneous puncture pathways were successfully established in 86 cases, 65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3±17.2)min, and the hemoglobin decreased in (10.1±4.5)g/L.The hospitalization time of the patients was (7.2±5.2)d.The first stage stone clearance rate was 74.4%(64/86), and the second stage stone clearance rate was 95.3%(82/86). Conclusion Combined with the advantages of X-ray and ultrasound, the puncture route shoud be designed by CT/IVP before operation, and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi. Key words: Kidney calculi; Urologic surgical procedures; Percutaneous nephrolithotomy; Nephrostomy, percutaneous; Diagnostic techniques, urological; Radiography; Ultrasonography; Punctures

The comparative study of one-stage and installment percutaneous nephroscope lithotripsy on the treatment of complex infection of upper urinary tract calculi

Objective To investigate the evaluation and significance of procalcitionin (PCT) for the degree of infection after postoperative infection of urinary calculi (PCNL, URL). Methods The clinical data with 52 cases of moderate fever was recorded more than (≥38.1 ℃)after endoscopic lithotripsy for upper urinary tract stones diagnosed with urinary tract infection patients as observation group from January 2015 to December 2016, another 52 cases of low-grade fever(<38 ℃)or no fever(according to the diagnostic criteria of bacterial urinary tract infection pathogens: no infection or partially unable to diagnosis of bacterial urinary tract infection)as control group.The difference between two groups with temperature changes(the highest temperature), blood leucocyte change, the proportion of neutrophils, c-reactive protein changes, PCT, Urine culture and blood culture was analyzed retrospectively. Results PCT and CRP level of observation group was obviously higher than that of control group, the difference was statistically significant(P<0.05). There was no statistical significance in blood leukocyte and neutrophil percentage of two groups.As the change of temperature, PCT and CRP of each group also had obvious difference(P<0.05). Conclusions PCT has advantages of test quickly, less noise, it will apply to the early diagnosis after endoscopic lithotripsy for upper urinary tract stones, determine the degree of infection and progression of the disease, especially has guidance value on the early diagnosis and timely treatment of bacteremia. Key words: Urinary Calculi; Nephrostomy, Percutaneous

Effect of percutaneous nephroscopy combined with flexible ureteroscope on BMG and BUA of complex renal calculi and its clinical efficacy

Objective To analyze the clinical effect and safety of percutaneous nephroscopy combined with soft ureteroscopy in the treatment of complicated renal calculi. Methods From January 2015 to October 2017, 120 cases of complicated renal calculi in our hospital were retrospectively selected. The patients in the control group were treated with minimally invasive percutaneous nephrolithotripsy and the patients in the observation group were treated with minimally invasive percutaneous nephrolithotomy combined with ureteral soft lithotripsy. The clinical effect of two groups was analyzed after treatment. Results Operation time, exhaust time, hospitalization time of the observation group were shorter than the control group, intraoperative bleeding was less than the control group (P 0.05). After the treatment, BMG, BUA, NGAL, Cys-C, hs-CRP, Ang I and Ang II levels of the observation group were lower than the control group (P<0.05), and the incidence of complications in the observation group was 8.33%, the control group was 21.67%, and the rate of complications in the observation group was lower than that of the control group (P<0.05). Conclusions Percutaneous nephrolithotomy combined with flexible ureteroscopy for the treatment of complex renal calculi can reduce blood loss, shorten hospitalization time, relieve stress reaction, and has little effect on renal function and safety. Key words: Kidney Calculi; Ureteroscopy; Nephrostomy, Percutaneous; beta 2-Microglobulin; Uric Acid

Comparative study of percutaneous nephroscopy surgery and laparoscopic surgery for the treatment of simple renal cysts

Objective To compare the efficacy and safety of percutaneous nephroscopy surgery and laparoscopic surgery for the treatment of simple renal cysts. Methods Forty patients with simple renal cysts were retrospectively analyzed from April 2012 to December 2016. They were treated by laparoscopic renal cyst unroofing decompression (laparoscopic group, 20 cases) and percutaneous nephroscopy cyst unroofing decompression (percutaneous nephroscopy group, 20 cases). The mean operation time, operation bleeding, the rate of postoperative complications (infection, fever, urine leakage), hospitalization time after operation, and follow-up data after 6 months were compared between the two groups. Results All the 40 operations were successfully performed. The clinical cure rate of two groups was 100%, the mean operation time, the operation bleeding, postoperative complications and hospitalization time after operation between the two groups were not significant difference. The postoperative drainage of percutaneous nephroscopy group was more than that of laparoscopic group, the difference was statistically significant (P<0.001). During the follow-up of 6 months, no recurrence was found in the two groups, patient's satisfaction of percutaneous nephroscopy group was better than laparoscopic group, the difference was statistically significant (P<0.001). Conclusions Percutaneous nephroscopy and laparoscopic surgery are effective and security for the treatment of simple renal cyst. At present, percutaneous nephroscopy cyst unroofing decompression is an alternative method and is worth promoting with the increase of experience. Key words: Kidney Diseases; Cysts; Laparoscopy; Decompression, Surgical; Nephrostomy, Percutaneous

The significance of the immediate drainage in urinary stones with infection

Objective To discuss drainage as soon as possible for the treatment of urinary stones with infection on the necessity and importance and security. Methods Between December 2015 and December 2016, clinical data of 45 patients with urinary stones with infection were analyzed, 22 patients were treated by percutaneous nephroscope and 23 cases of patients underwent ureteral stent implantation. All patients admitted to hospital with different degree of fever, different degrees of perirenal exudation in the affected sides of the patients and routine blood WBC, neutrophil percentage(NEU%), C-reactive protein(CRP), Serum procalcitonin(PCT), higher routine urine white blood cells increased. All patients were performed micro-colostomy drainage under local anesthesia by percutaneous nephroscope or ureteral stent implantation under cystoscope within 2-24 h after preoperative examination, and stage II endoscopic lithotripsy after controlling infection. Results All patients were successfully completed surgery. Preoperative temperature (38.60±0.87)℃, the third day after the body temperature of (36.80±0.21)℃ were found, compared with preoperative body temperature, there was significant difference(P<0.05). Preoperative routine blood leukocytes was (18.2±1.2)×109/L, three days after treatment was (5.6±1.4)×109/L, there was significant difference(P<0.05). There was significant difference in neutrophil percentage, CRP and PCT preoperation and third day after operation[(91.3±4.1)% vs.(65.2±6.2)%, (96.3±21.4)mg/L vs.(21.3±3.2) mg/L, (8.3±2.2) vs.(0.07±0.01), P<0.05]. No septic shock occurred in all patients. Conclusions Immediate drainage on urinary stones with infection is crucial, it should control infection as soon as possible to reduce the incidence of septic shock. Key words: Urinary Calculi; Cross Infection; Drainage

Application progress of renal anatomy in percutaneous nephroscopy

任何外科手术首要解决的都是解剖结构问题，不管是传统开放手术，还是现在广泛应用的微创手术。经皮肾镜碎石取石术(percutaneous nephrolithotomy，PCNL)操作更加精细，对局部解剖有着更高的要求。PCNL是治疗上尿路结石，尤其是复杂性上尿路结石的首选方式。尽管目前的设备和技术已经取得长足的进步，但仍有约四分之一的患者出现PCNL术后并发症，对整体手术效果和患者预后影响极大。精准穿刺并建立安全的操作通道是经皮肾镜手术中最重要的一步，而对肾脏解剖结构的系统把握是关键所在。本文将就肾脏解剖在PCNL中的应用进展作一综述，以期推动经皮肾镜技术更加安全，高效和精准化发展。

Postoperative stress response in patients with kidney stones after micro-channel and standard channel percutaneous nephroscopy lithoipsy

Objective To discuss the postoperative stress response in patients with kidney stones after micro-channel and standard channel percutaneous nephroscopy lithoipsy(PCNL). Methods One hundred patients with kidney stones were selected from June 2013 to June 2017 in our hospital, all patients were randomly divided into micro-channel group and standard channel group, 50 cases in each group, micro-channel group was given micro channel(F16) PCNL treatment, standard channel group was given standard channel (F24) PCNL treatment. Results The intraoperative blood loss, leaving bed time, bowel function recovery time, hospital stay time, complication rate of micro channel group were significantly lower than those of standard channel group, the difference was statistically significant (P 0.05). The postoperative serum cortisol (COR), adrenocorticotropic hormone (ACTH) levels of micro channel group and standard channel group were significantly higher than before operation, the postoperative serum COR, ACTH levels of micro channel group were significantly lower than those of standard channel group, the difference was statistically significant (P<0.05). Conclusions Compared with standard channel, micro-channel PCNL treatment also has a curative effect for kidney stones, which can effectively reduce the surgical trauma and postoperative stress reaction of patients, it is beneficial to reduce the complications and physical recovery of patients, it’s worth for further clinical promotion. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Stress

Relation between renal pelvic pressure and ratio of endoscope-sheath diameter during percutaneous nephrolithotomy

Objective To observe the influence of ratio of endoscope-sheath diameter on renal pelvic pressure during PCNL. Methods The model of 24 isolated adult porcine kidneys were used to imitate percutaneous nephrolithotomy from September 2016 to June 2017. Each tract was established ( F12, F14 and F16). Three kinds of endoscopes (F8 all-seeing needle percutaneous nephroscope, F6/7.5 and F8/9.8 rigid ureteroscope), input a 200μm laser, were adopted. There were 8 combinations, and 3 kidneys were used for each one. Renal pelvic pressure was measured 3 times repeatedly in every combination with steady irrigation (50, 100, 150, 200, 250, 300, 350, 400, 450, 500 cmH2O). Results The linear equations, ratios of endoscope-sheath diameter and highest renal pelvic pressures for each combination were: F8-F12, Pr=0.026P0-1.533, 0.67, 12.2±0.54; F6/7.5-F12, Pr=0.112P0-5.001, 0.92, 51.2±0.93; F8-F14, Pr=0.010P0+ 1.067, 0.58, 6.2±0.48; F6/7.5-F14, Pr=0.020P0+ 1.000, 0.79, 10.8±0.46; F8/9.8-F14, Pr=0.144P0+ 20.933, 0.87, 84.7±1.17; F8-F16, Pr=0.005P0+ 1.067, 0.50, 2.8±0.34; F6/7.5-F16, Pr=0.009P0+ 0.533, 0.68, 5.1±0.32; F8/9.8-F16, Pr=0.020P0+ 2.200, 0.75, 12.6±0.56. The combinations of F6/7.5-F12 and F8/9.8-F14 might lead to a high renal pelvic pressure without proper irrigation (<401.7 cmH2O for F6/7.5-F12; <132.4 cmH2O for F8/9.8-F14). Conclusion In order to keep a safe pressure, a proper ratio of endoscope-sheath diameter (<0.80) and appropriate irrigation must be considered. Key words: Percutaneous nephrolithotomy; Renal pelvic pressure; nephrostomy tract size; Ratio of endoscope-sheath diameter

Laparoscopic combined with percutaneous nephroscopic necrosectomy for peripancreatic abscesses: a report of 8 cases

Objective To study the effect of combined laparoscopic and percutaneous nephroscopic necrosectomy in the treatment of peripancreatic abscesses. Methods The clinical data of 8 patients with peripancreatic abscesses treated by combined laparoscopic and percutaneous nephroscopic necrosectomy in our hospital from June 2015 to June 2017 were retrospectively analyzed. Results 8 patients were treated with percutaneous puncture and drainage under Ultrasonic / Computed Tomography guidance. Combined laparoscopic and percutaneous nephroscopic necrosectomy was then carried out. Two patients underwent percutaneous nephroscopic surgery twice and laparoscopic surgery once, and 3 patients underwent percutaneous nephroscopic surgery thrice, and 3 patients underwent percutaneous nephroscopic surgery 4 times and laparoscopic surgery once. One patient after percutaneous nephroscopic necrosectomy was complicated with sinus tract hemorrhage, which was treated by haemostasis through a small incision. Two patients who developed postoperative colonic fistula were treated successfully by conservative treatment. The average length of hospital stay was 80 d (60~153 d), and there was no death. Conclusion Combined laparoscopic and percutaneous nephroscopic necrosectomy was a minimally invasive and efficacious method to treat peripancreatic abscesses. Key words: Pancreas abscess; Pancreatitis, infected necrotizing; Laparoscopy; Percutaneous nephroscopy; Necrosectomy

Effect of standard percutaneous nephroscope combined with bladder soft lens lithotomy in the treatment of serum Hcy, β2MG in kidney stone

Objective To discuss the effect of standard percutaneous nephroscope combined with bladder soft lens lithotomy in the treatment of serum homocysteine (Hcy), beta 2-microglobulin (β2MG) in kidney stone. Methods A total of 100 patients with kidney stone were selected from December 2013 to December 2016 in our hospital, and all patients were randomly divided into double lens and renal lens group, 50 cases in each group, renal lens group was given standard percutaneous nephrolithotomy (PCNL) treatment, the double lens group was given standard percutaneous nephroscope combined with bladder soft lens lithotomy treatment. Intraoperative blood loss, operation, bowel function recovery, length of hospital stay, the issue of stone removal, complications and pain before and after treatment, serum Hcy, β2MG levels were statistical analyzed. Results The intraoperative blood loss, bowel function recovery, length of hospital stay, the incidence of complication of double lens group were significantly lower than thosed of renal lens group, the first phase stone clearance rate, operation time of the former were significantly higher than those of the latter, the differences were statistically significant (P<0.05). The 1, 4 d after treatment, VAS scores, serum Hcy levels of double lens and renal lens group compared with before treatment were increased, the serum β2MG level was increased, but the change of former was significantly more than that of the latter, the difference was statistically significant (P<0.05). Conclusions Standard percutaneous nephroscope combined with bl- adder soft lens lithotomy can improve the treatment of patients with kidney stones and reduce complications and surgical trauma, and it can improve the level of serum Hcy, β2MG, it is beneficial to patients' pain relief, recovery, but it still need to improve the relevant operation technology. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Cystoscopes; beta 2-Microglobulin

The clinical diagnosis and treatment of enterococcus faecium after percutaneous nephrolithotripsy

Objective To investigate characteristics of enterococcus faecium after percutaneous nephrolithotripsy, to guide clinical rational drug- usage. Methods Retrospective analysis of 16 cases of percutaneous nephroscope lithotripsy postoperative urine culture confirm excrement enterococcus infection was performed. Regular analysis of blood in the urine, urine culture and drug susceptibility, fever and outcome after replacement of vancomycin was performed. Results The first symptoms of 16 patients were fever and chills, temperature was above 39 ℃. Reduction of body temperture of empirical single or double using conventional antimicrobial therapy after 1 week was not obvious, the total number of white blood cells in the blood routine, neutrophil percentage, C-reactive protein and calcitonin developed continuously, body temperature of patients significantly decreased by intravenous drip vancomycin after 3~5 days, anti-inflammatory 1~2 weeks later, all the patients were cured and discharged, without septic shock. Conclusions After percutaneous nephroscope lithotripsy, postoperative recurrent fever, chills, and empirical single or double using conventional antimicrobial therapy won’t help for patients who should be wary of excrement enterococcus infection, vancomycin is still the first choice for treatment of urinary tract excrement enterococcus infection drugs. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Enterococcus

Prospective comparative study of ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery in treatment of moderate-sized renal lower caliceal calculi

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi. Methods From March 2015 to December 2016, patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed. Patients were randomized into two groups according to the random number table. Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm. 200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent. In Group RIRS, all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared. Results 100 patients were enrolled in the study 50 patients in Group UMP, 28 were male and 22 were female, mean age was 43.4±7.9 years old.Mean stone size was 14.5±3.0 mm(range 10-22 mm). Among them, 18 cases were complicated with mild and moderate hydronephrosis. The other 50 cases were allocated to Group RIRS, including 31 males and 19 females.Their mean age was 44.5±8.3 years old and mean stone size was 13.7±3.1mm (range 10-21 mm). Among them, 16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups(P>0.05). After three months’ follow-up, one-time stone free rate(SFR) of UMP group was 94.0%(47/50), which was significantly more superior than the 72.0%(36/50) of the RIRS group(P 0.05). Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi. Compared with RIRS, UMP may be more effective and has less operating time, however wtih more intraoperative blood loss. Key words: Renal lower caliceal calculi; Ultra-mini percutaneous nephrolithotomy; Flexible ureterorenoscope; Holmium laser; Prospective study

Curative effects of mPCNL in semi-supine anterolateral position for complicated renal stones

Objective To evaluate the clinical effect, safety and indication of mini-percutaneous nephroscope lithoipsy (mPCNL) in semi-supine anterolateral position for complicated renal stones. Methods From January 2010 to June 2016, clinical data of 360 patients with complicated renal stones who divided into prone position, lateral decubitus position and semi-supine anterolateral position group were retrospectively reviewed.Factors such as stone-free rate (SFR), operation duration, complications hospitalization time were analyzed among the three groups. Results All operations were successful. The mean operation time of the semi-supine anterolateral position groups was(65±24)min, 1 patient had colon injury, 4 patients had pyelocaliceal perforation, the SFR was 89.2% (214/240). The blood loss, stone-free rate, complications and position comfort after one session by semi-supine anterolateral position were significantly advantageous compared with the other body positions. Conclusions mPCNL in semi-supine position is an safety and effective method to deal with complicated kidney stones with a high success rates and a quite low complication. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Posture

The value of intra-cavitary contrast enhanced ultrasound in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis

Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis. Methods From March 2016 to March 2017, ICCE-US-guided PCNL was performed in 35, patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24. The sample comprised 20 males and 15 females, including 10 with renal pelvic calculi alone, 17 with renal pelvic calculi combined with renal calyx calculi, and 8 with partial staghorn calculi. Mean age was 46.8 years (ranging, 28-75 years). The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6±1.2)cm]. In the prone position, the preferred calyces are the posterior ones, which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter. An 18-gauge needle was inserted toward the desirable calyx. Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed. A guidewire was passed through the needle to renal collecting system. Subsequently, the needle was removed. And the renal tract was dilated to F18-F20 size with dilators. Finally, holmium laser lithotripsy was performed through nephroscopy. Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100%. The average time for establishing the access was (8±2.6)min (ranging 5-10 min). The mean number of needle passes was (1.5±0.3)times per kidney, ranged from 1 to 3 times. Hemoglobin level averagely reduced(11.3±3.7)g/ L (ranging 6-15 g/L) within 24 hours postoperatively. No major complications, such as adjacent organs injuries or collecting system perforation were observed. No blood transfusion was needed. The mean hospital stay was(5.6±1.2)days (ranging 5-7 days). The stone-free rate was 91.4%(32/35). Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis. It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications. Key words: Percutanous nephrolithotomy; Ultrasound contrast agents; Nephrolithiasis

Comparison of curative efficacy of two kinds of treatments for upper ureteral calculi under the same learning curve

Objectives To compare the efficacy of percutaneous nephroscope lithotripsy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (RLUL) in the treatment for ureter-stuck stones by the same doctor under the same learning curve. Methods 92 patients with obstructive upper ureteral calculus from August 2008 to August 2014 in our hospital were selected, according to the digital method who were randomly divided into PCNL group and RLUL group, each of 46 cases. The peration time, peroperative bleeding, postoperative fever rate (>38. 5℃), postoperative bleeding, rate of residual stones in the ureter, hospitalization time were compared. Results All the operations were completed. Peroperative bleeding of PCNL group and RLUL group was(58.02±27.16)mL, (21.74±10.18)mL, respectively. Hospitalization time of PCNL group and RLUL group was(9.07±0.77)d, (7.59±0.88)d, respectively. There were statistically significant differences in rate of residual stones between the PCNL group and RLULgroup (P <0.05). The patients were followed up for 1 to 36 months (mean, 10 months), no recurrence was found in both groups. Conclusions Both PCNL and RLUL are safe, effective, and feasible for incarcerated upper ureteral calculi. Key words: Ureteral Calculi; Nephrostomy, Percutaneous; Laparoscopes

Super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided for pediatric kidney stones

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided renal access in pediatric with renal calculus. Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean(1.48±0.59) cm. Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2. All patients had no previous surgery treatment. The SMP system consists of a F6.0-7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function. Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter. Nephrostomy tube or double J stent was placed only if clinically indicated. Results The stone size was 0.8-2.5 cm, mean(1.48±0.59)cm. Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones. All the patients were completed successfully without surgery conversion. Mean operative time ranged 6-40 minutes , mean( 17.6±11.6) minutes. The stone free rate was 100% after the evaluation in the postoperative day. The hemoglobin drop was 2-16 g/L, mean(7.6±4.1) g/L. No major complications occurred, neither patient required transfusion. The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients. Only 14 patients had a ureter catheter placement for one day. The average hospital stay ranged 1-4 days, mean (2.4±0.8) days. Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement. SMP could be the ideal procedure for children with upper urinary tract calculus. Key words: Pediatric; Upper urinary; Calculus; Super mini-percutaneous nephrolithotomy(SMP)

The applied research urinary tract made pockets for percutaneous renal postopera-tive fistula mouth drainage collection

Objective To explore the clinical effect of urinary tract made pockets for percutaneous renal postoperative fistula mouth drainage collection.Methods A total of 32 patients who were given percutaneous nephroscope lithotomy （PCNL） postoperative renal fistula with much wound drainage , were divided into experimental group and control group randomly , 16 cases in each group.The experimental group were given urinary bag to collect the drainage , the control group were given the conventional method to treat the drainage.The uncom-fortable cases, wound surrounding skin with and without hot flashes , number of wound care , nursing time and the cost of two groups were compared.Results The feel uncomfortable cases , flush on the surrounding skin wound cases , number of wound care , nursing time and cost compared had significant differences between the two groups （ P〈0.05 ） .Conclusions Using the urinary tract made bag collected PCNL postoperative renal fistula mouth drainage can improve patient comfort and protect the skin around the wound , reduce the incidence of wound infection, reduce the switching frequency , thereby saving switching cost , and can accurately record the drainage volume , improve the effect of wound care. Key words: Urinary tract made pockets; Renal made fistula mouth; Drainage; Collection