Treatment Of Renal Calculi Research Articles

Treatment of renal calculi without hydronephrosis using a standard channel assisted by a visual puncture system.

ObjectiveTo study the safety and efficacy of standard channel establishment using a visual puncture system in the treatment of renal calculi without hydronephrosis.MethodsWe retrospectively analyzed data from 46 patients undergoing percutaneous nephrolithotomy via a standard channel assisted by a visual puncture system, including number of punctures, duration of procedure, hemoglobin level after surgery, calculi clearance rate, and postoperative complications.ResultsSixty-nine channels were established, including a single channel in 26 cases, double channel in 17 cases, and three channels in 3 cases. The mean number of punctures was 1.50, mean time to establish the standard channel was 2.6 minutes, and duration of surgery was 31.3 minutes. No significant change in hemoglobin was observed after surgery. Forty-three patients had no residual calculi and three had small residual calculi on the day after surgery, representing a first-phase clearance rate of 93.48% (43/46). No significant complications were observed.ConclusionsHemorrhage during operation can be significantly reduced by establishing a standard channel using a visual puncture system. Moreover, the number of standard channels can be reduced and the incidence of complications lowered using this approach, which should be adopted widely for the treatment of renal calculi without hydronephrosis.

Outcomes of Retrograde Intra-Renal Surgery

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) & 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

Comparison of ureteral soft endoscopy and pneumatic lithotripsy in the treatment of renal calculi and its effect on serum NGAL, WBC level

Objective To investigate the effect of ureteral soft endoscopy and pneumatic lithotripsy in patients with renal calculi and its effect on serum NGAL, WBC level. Methods From September 2015 to September 2016, 216 patients with renal calculi were randomly divided into two groups: control group (n=108) and observation group (n=108). The observation group was treated with ureteral soft lithotripsy and the control group with pneumatic lithotripsy.The success rate of lithotripsy, the incidence of adverse reactions, the time of hospitalization, the time of operation, the amount of intraoperative bleeding and the level of NGAL were compared between the two groups. Results There was no significant difference in the success rate of lithotripsy between the observation group (79.31%) and the control group (72.41%). The incidence of adverse reactions in the observation group was 5.17%, which was significantly lower than that in the control group (17.24%). The postoperative hospitalization time, operation time and intraoperative bleeding volume in the observation group were significantly lower than those in the control group(t=10.166, P=0.000; t=18.245, P=0.000; t=25.296, P=0.000). Before operation, there was no significant difference in WBC, CRP, NGAL and Scr between the observation group and the control group(P>0.05). The levels of NGAL in the observation group were significantly lower than those in the control group at 24, 48 and 72 h after operation(t=5.316, P=0.000; t=4.969, P=0.000; t=3.319, P=0.000). Twenty-four hours after operation, the levels of WBC, CRP and Scr in the observation group were lower than those in the control group(t=5.127, P=0.000; t=3.280, P=0.001; t=3.687, P=0.000). Conclusions Compared with pneumatic lithotripsy, soft ureteroscopic lithotripsy has the advantages of less adverse reaction, shorter operation time, less bleeding and less damage to renal function. Key words: Kidney Calculi; Ureteroscopy; Lithotripsy; Lipocalins; Leukocytes

Combined Laparoscope and Flexible Ureteroscope Pyelolithotomy Dealing with Large-Burden Complex Renal Calculi in Children Less Than 1 Year Old.

Objective: To evaluate the experience and result of combined laparoscope and flexible ureteroscope (f-URS) pyelolithotomy in dealing with large-burden complex renal calculi in children <1 year old. Methods: Eleven patients (7 males and 4 females) <1 year old were retrospectively reviewed between December 2015 and May 2017, who had been diagnosed with renal calculi and received combined laparoscope and f-URS pyelolithotomy. The operations were carried out under general anesthesia. Patient' characteristics, presenting symptoms, operative times, and blood loss, stone-free rate, and postoperative complications were all collected retrospectively. Results: All 11 patients received combined laparoscope and f-URS pyelolithotomy. All operations went smoothly without conversion record and blood transfusion. Average time consumed was 109 minutes (55-187 minutes), and blood loss reported was 16 mL (10-25 mL). Average hospital stay after operation was 7 days (5-11 days). On mean follow-up of 6-12 months, no symptomatic urinary tract infections and urinary calculi were detected. Conclusion: Laparoscope combined f-URS pyelolithotomy is considered safe in the treatment of large-burden multiple renal calculi in infant patients with a high stone clearance rate. It has certain advantages in the treatment of renal calculi in infants <1 year old, and it could be an alternative treatment when other treatments fail or are unavailable.

Comparative study of balloon dilatation and ureteral guide sheath dilation in the treatment of renal calculi with flexible ureteroscopy

Objective To explore the balloon dilatation and ureteral guide sheath expansion in the treatment of renal calculi with flexible ureteroscopy. Methods From July 2017 to December 2017, 35 cases of renal calculi were treated by phase I ureteroscopy in our hospital. All patients were randomly divided into the observation group (using balloon dilatation) and the control group (using the ureteral guiding sheath dilatation). Two groups of patients were observed in the first phase of treatment success, complications and hospitalization time and hospitalization expenses and other social indicators. Results The results showed that there was no significant difference between the two indexes of the operation time and the time of hospitalization in the two groups. It showed that the two expansion methods did not increase the recovery time of the patients, but the hospitalization cost of the observation group was significantly higher than the control group (P 0.05). The incidence of complications in the two groups was analyzed, and the incidence of complications in the observation group was significantly lower than the control group (P 0.05). Conclusions From the point of view of complications, the two types of dilatation are all safe, but the incidence of complications in the balloon dilatation group is lower, but the cost of balloon dilatation in hospitalization is significantly higher than ureteral guidance sheath expansion because of the balloon as a disposable medical consumable. The two methods have their own advantages. It is suggested that suitable methods should be chosen when clinical application. Key words: Kidney Calculi; Dilatation; Ureteroscopy

Super-Mini Percutaneous Nephrolithotomy Reduces the Incidence of Postoperative Adverse Events in Pediatric Patients: A Retrospective Cohort Study

Objective: To assess the safety of the super-mini percutaneous nephrolithotomy (SMP) versus the minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of pediatric renal calculus. Methods: We retrospectively reviewed the electronic records of pediatric patients who underwent treatment for renal stones by either SMP or MPCNL from May 2015 to May 2016. We compared the safety of the 2 surgical procedures in the treatment of renal calculus in children by using the generalized estimating equation (GEE) multivariate regression analysis, in which the exposures are the surgical procedures and postoperative adverse events (postoperative complications, fever, and WBC counts) are set as outcome variables. Results: The study included 39 patients (26 boys and 13 girls), of which 22 underwent MPCNL and 17 underwent SMP, with a mean age of 110.05 ± 45.01 and 93.18 ± 41.72 months, respectively. In the univariate logistic regression model, the surgical procedures showed no significant association with postoperative complications (95% CI 0.0–1.5), fever (95% CI 0.1–2.1), postoperative peripheral WBC (95% CI 0.1–2.2). In the multiple logistic regression analysis, there was an insignificant association between surgical methods and postoperative complications (95% CI 0.28–1.1), fever (95% CI 0.1–1.2), and postoperative peripheral WBC (95% CI 0.03–1.8). While using GEE with multiple dependent variables and MPCNL as a reference, the OR of adverse events was 0.15 and the 95% CI were 0.04–0.55. Conclusions: Compared to MPCNL, SMP has a lower incidence of postoperative complications and appears to be a safer treatment for children with kidney stones.

Safety and Efficacy of Supracostal Approach for Percutaneous Nephrolithotomy (A Prospective Study)

AbstractBackground: The management of large kidney stones is still one of today's topics in endourology. Supracostal Percu-taneous Nephrolithotomy (PCNL) is found to be a highly effective procedure in treatment of renal calculi. However, many factors are affecting the safety and efficacy of the procedure.Aim of Study: The aim of this study was to evaluate the factors that affect the safety and efficacy of supracostal PCNL in kidney stones.Patients and Methods: Fifteen patients with renal calculi underwent supracostal percutaneous nephrolithotomy either with single access or multiple accesses. Pre-operative, operative and post-operative data were reported. Multivariate analyses as well as univariate analyses were used to investigate the effects of different variables on residual stones and blood transfusion rate. These factors include age, sex, laterality, body mass index, history of ipsilateral open renal surgery, operative time, and stone density.Results: The study included 15 patients with mean stone size is 2.5cm±0.6, all stones were radiopaque with mean HFU 969±134, R, 4 patients had upper calyceal stone (26.7%), 9 patients had stone pelvis and upper calyx (60%), and 2 patients had complex stone. (13.3%), 9 patients had multiple kidney punctures (60%) and 6 patients had single kidney puncture (40%), one case had positive signs of hydrothorax intraoper-atively (6.7%) by fluoroscopy, one case had pelvic perforation (6.7%), mean operative time was 105 minutes ±0.23, post-operative chest X-ray revealed positive signs in 2 cases (13.4%) with mild symptoms and needed no intervention, 1 case had significant post-operative bleeding (6.7%) and needed blood transfusion, mean hospital stay time was 2.7 days ±1.8, residual stones were encountered in 4 cases (27%).Conclusion: Supracostal PCNL is a safe and effective procedure for kidney stones more than 2cm. The stone free rate in the study was related mainly to patient’s comorbidities like BMI, stone size and site. Chest complications needed intervention in only one case, later on was completely free.

The analysis of the application of holmium laser in the treatment of renal calculi

Objective To explore the clinical application of flexible ureteroscopy combined with holmium laser in the treatment of renal calculi. Methods From April 2013 to June 2014, 100 cases of renal calculi were treated in our hospital . According to the distribution of stone position, 55 cases of renal pelvis and renal upper calculi and 45 cases of lower renal calculi were treated with ureteroscopy combined with holmium laser. Evaluation of ureteroscope combined with holmium laser in double kidney CT plain scan was performed after 30 days. Results The success rate of the primary mirror was 96.00%, the proportion of the stones found in the operation was 95.00%, the rate of searching for the upper calculi in the renal pelvis and kidney was 96.36% (53/55), and the rate of searching for the lower renal calyx stones was 93.33% (42/45). The total successful lithotripsy rate was 86.32% (82/95). The successful lithotripsy rate of the renal pelvis and kidney stones was 92.45% (49/53), and the success rate of the lower renal calyx lithotripsy was 78.57% (33/42). The difference between the two groups was statistically significant (P<0.05). A few patients developed minor complications such as fever, lumbago and gross hematuria. No serious complications occurred. After the operation, the results of the patients were good after 30 days, the total stone exclusion rate was 82.92% (68/82) after the operation, and the clearance rate of the upper pyelolithiasis in the renal pelvis and kidney was 93.87% (46/49), and the rate of drainage of the lower renal calyx after operation was 66.67% (22/33). The difference between the two groups was statistically significant (P<0.05). Conclusions Ureteroscopy combined with holmium laser has a comprehensive, safe and effective treatment for renal calculi, and can reduce the incidence of complications. It is worthy of clinical promotion. Key words: Kidney Calculi; Holmium; Lasers, Solid-State; Ureteroscopes; Lithotripsy, Laser

Effect of the ultrasound-guided transperitoneal percutaneous nephrolithotomy in treatment of renal calculi in pelvic ectopic kidney

Objective To evaluate the safety and efficacy of ultrasound-guided transperitoneal PCNL for treatment of renal calculi in pelvic ectopic kidney. Methods The clinical data of 4 cases of pelvic ectopic kidney treated in our hospital from June 2016 to August 2017 were retrospectively analyzed. The patient's age ranged from 30 to 67 years with an average of 47.25 years. There were two male and two female patients. 2 cases suffered with left pelvic ectopic kidney stones. One case had right pelvic horseshoe ectopic kidney stones and one case had spinal deformity left pelvic ectopic kidney stones. Multiple stones were found in 2 cases. The mainly stones located in the renal pelvis in one case. Multiple stones in the lower calyx was found in another case. The remaining 2 cases had single stones in the renal pelvis. Stone size was 3.4 cm×2.1 cm, 3.0 cm×2.1 cm, 2.8 cm×2.4 cm and 2.1 cm×1.9 cm respectively. And 1 case with renal calculi in left pelvic ectopic kidney had a history of open surgery 11 years ago because of the same situation with pelvic ectopic kidney calculi. In this study, all operation was performed under general anesthesia. The ultrasound-guided percutaneous nephrolithotomy combined with preoperative CTU and intraoperative color Doppler ultrasound was used to find the target renal calyx or renal pelvis. And a certain pressure was applied to the abdominal wall to make the intestinal canal deviate from the surface of the pelvic ectopic kidney as much as possible. Under ultrasound real-time detection, it was punctured into the target renal calyx or renal pelvis to find and break stones. And F6 double J tube and F18 nephrostomy tube were left. Operative and post-operative related details (stone free, bleeding, abdominal infection) were reviewed. Results Stone free rate were 100% (4/4). The time of operation and hospital stay were 62, 59, 55, 51 min and 6, 6, 5, 5 days, respectively. None had significant intraoperative and postoperative complications, including haemorrhage, injury of mesenteric vessels, abdominal infection and hydrops. No one left residual stones during 1 month and 3 months of follow-up. Conclusions The ultrasound-guided transperitoneal PCNL is a safe and effective procedure for the treatment of patients with renal calculi in pelvic ectopic kidney. Key words: Percutaneous nephrolithotomy; Transperitoneal; Ultrasound-guided; Pelvic ectopic renal calculi

AB015. How to do the combined ureteroscope well

How to do a combined ureteroscopy lithotripsy surgery? Procedures of combined flexible ureteroscopy: (I) double J tube was retained before surgery; (II) inserting the zebra guide wire; (III) inserting the ureteral sheath; (IV) into the mirror; (V) smashing stone. Experience: (I) treatment of cast stone; (II) treatment of bilateral renal calculi stage I in difficult position; (III) management of repeated kidney stones; (IV) treatment of renal calculi without indwelling ureteral sheath. Taste: (I) preparation before surgery; (II) the use of combined ureteroscope; (III) use of soft ureteroscope kit. Lesson (I) urinary sepsis; (II) formation of stone street; (III) ureteral injuries. Expectation Ureteroscope combined with holmium laser is entering the first-line clinical treatment, we believe that with the improvement of soft ureteroscopy and laser technology, soft ureteroscopy will bring a new leap in the treatment of stones in our urology department!

Comparative study of clinical effect of percutaneous nephrolithotomy and flexible ureteroscope lithotripsy in the treatment of renal calculus ≤2 cm

Objective To compare the effect, postoperative inflammatory response, stress response differences of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of renal calculus with a diameter ≤2 cm. Methods One hundred and twenty-eight patients with renal calculus ≤2 cm m in Beijing Pinggu Hospital were enrolled in the study and were randomly divided into PCNL group(64 cases) and FURL group (64 cases). The treatment of PCNL and FURL was carried out respectively.The stone clearance rate, operation time, hospitalization time, the number of painkillers used after surgery, inflammatory index (hs-CRP, IL-6), oxidative stress index (MDA, SOD) were compared. Results There was no significant difference in the stone clearance rate between PCNL group and FURL group (χ2=0.208, P>0.05). The operation time of PCNL group was (55.32±5.80) min, which was shorter than that of FURL group ((65.21±4.24) min), the difference was statistically significant (t=16.322, P<0.01). The hospitalization time of FURL group was (4.50±1.20) d, which was shorter than that of FURL group ((7.40±1.80)), the difference was statistically significant (t=9.441, P<0.01). The number of painkillers used after surgery in the FURL group was (0.35±0.14) times, which was less than that in FURL group ((0.85±0.24) times), the difference was statistically significant (t=8.625, P<0.01). The postoperative hs-CRP of FURL group (10.62±1.26) mg was significantly lower than that in PCNL group (19.42±1.35) mg/L, The difference was statistically significant (t=12.734, P<0.01). The postoperative IL-6 of FURL group was(31.50±6.57) ng/L, significantly lower than the PCNL group(38.72±6.25) ng/L, the difference was statistically significant (t=5.839, P<0.01). The postoperative MDA of FURL group (0.63±0.17) mmol/L was significantly lower than that of the PCNL group (0.80±0.20) mmol/L, The difference was statistically significant (t=4.288, P<0.01). The postoperative SOD of FURL group (80.40±5.80) U/L was significantly higher than the PCNL group(74.30±7.40) U/L, the difference was statistically significant (t=4.691, P<0.01). The incidence of postoperative complications in PCNL group was 10.94% (7/64), FURL group was 2.17% (1/64), the difference was statistically significant (χ2=4.800, P<0.01). Conclusion FURL has the characteristics of less intraoperative blood loss, less trauma, less postoperative pain and fewer complications in the treatment of renal calculus ≤2 cm, which has less smaller inflammation, oxidative stress, and conducive to the patients′ postoperative recovery. Key words: Renal calculus; Percutaneous nephrolithotomy; Flexible ureteroscopic lithotripsy; Inflammatory reaction; Oxidative stress

Safety and Efficacy of Percutaneous Nephrolithotomy in Patients with Severe Skeletal Deformities.

Treatment of renal calculi in patients with severe skeletal deformities can be challenging. We present our experience in order to provide an assessment of technical difficulties, associated complications, and outcomes of percutaneous nephrolithotomy (PCNL) as a treatment option in this special patient group. Our study included eight patients treated with PCNL for renal stones. All had severe skeletal deformities including six with severe kyphoscoliosis, one with osteogenesis imperfecta, and another withrickets. After pre-operative evaluation the procedure was performed under fluoroscopic and/or ultrasonic guidance. In all but one case, PCNL was performed with the patient in the prone position. Silicone rolls and soft padded bolsters were used to obtain the best positioning for the procedure. Clearance rates and complications were assessed. Complete stone-free rate was achieved in six patients (75%) after first-PCNL. The two patients with residual stones underwent a second-look PCNL, after which one was completely cleared. The overall completestone-free rate after second PCNL was 87%. Only minor complications were seen in two patients (25%). We found PCNL to be safe and effective for managing kidney stones in patients with severe skeletal deformities.

Urolithiasis (Kalladaippu) - An Evidence Based Case Study

“KALLADAIPPU” (Urolithiasis) “KALPIRAMIYAM”(Urolithiasis) are the synonyms in Siddha and the term equated to renal calculi in allopathic system of medicines. An increasing affluence and adaptation of Western diet habits in many developing countries seem likely to contribute to the changes for the development of renal calculi. Siddha medicine describes certain formulations as Lithotriptic and diuretic which is used in the treatment of renal calculi successfully. This case reported again is an example that proves the efficacy of Siddha medicines for expulsion of renal stones. The synergistic action enhanced resulting in disintegration and elimination of urinary stones from urinary tract.

Clinical effect of flexible cystoscope lithotripsy combined with PCNL in the treatment of patients with renal calculi

Objectives To investigate the clinical efficacy and safety of percutaneous renal mirror (PCNL) combined with flexible cystoscope lithotripsy in the treatment of renal calculi. Methods 80 patients with kidney stones in our hospital were selected as the observation group (PCNL combined with flexible cystoscope lithotripsy), 80 patients with kidney stones underwent PCNL alone at the same period as the control group. Two groups of surgery-related indicators, concurrent disease and laboratory parameters were compared. Results There were no statistically significant differences in operative time, blood loss, tube-retained time, hospitalization time between the two groups (P>0.05). Stone clearance rate at I stage and after a month, reoperation rate in the observation group, were significantly higher than control group (P 0.05). The difference was not statistically significant in complication rate in the observation group and the control group (P>0.05). Conclusions PCNL combined with flexible cystoscope lithotripsy in the treatment of patients with kidney stones is better than alone PCNL, and it also has better security. Key words: Kidney Calculi; Cystoscopes; Nephrostomy, Percutaneous

AB199. Investigation of flexible ureteroscope and percutaneous nephrolithotomy in treatment of renal calculi (1–2 cm) on the effects of inflammatory reaction

ObjectiveBy detecting stress indicators related to discuss retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) those two different operations impact on the body’s inflammatory reaction, for renal calculi disease surgical methods of clinical evidence.MethodsRandomly 80 patients suffer unilateral renal calculi which 1–2 cm from September 2013 to September 2014 in the urology department of Guangdong No.2 Provincial People’s Hospital, Divide into flexible ureteroscope lithotripsy group 40 cases (group RIRS) and 40 cases in percutaneous nephroscopy group (group PCNL). Flexible ureteroscope lithotripsy group (21 males, 19 females); percutaneous nephroscopy group (20 males, 20 females). Respectively using peripheral venous blood of 10 mL of patients in the preoperative and postoperative 1 hour, postoperative 1st, 3rd, 5th day to adopt fully automatic blood cell analyzer to make determination of peripheral white blood cells (WBC), immune turbidity method to analysis concentration of blood C reactive protein (CRP), radioimmunoassay to measure blood concentration of cortisol (Cor), enzyme linked immunosorbent assay (ELISA) to measure interleukin 6 (IL-6) and interleukin 10 (IL-10) concentration. All the data using SPSS statistical software for statistical analysis, P<0.05 said the difference was statistically significant.Results(I) Related conditions of the operation. (i) Efficacy of the lithotripsy: group RIRS of patients with calculi one-time clearance rate was 87.5% (35/40), two cases of renal calyx calculi patients need DURL and had a successful treatment, one case of renal calyx diverticulum for the flexible ureteroscope rotation angle limit had failed to lithotripsy. The total clearance rate of renal calculi was 97.5% (39/40); group PCNL of patients with calculi one-time clearance rate was 85% (34/40), two cases of patients after the 2nd phase PCNL succeed, two cases with residual stone more than 2 mm. The total clearance rate of renal calculi was 95% (38/40). There was no statistically significant difference (P>0.05). (ii) Intraoperative condition: compared with the time of operation of group RIRS and group PCNL, there was no statistically significant difference (P>0.05). But the intraoperative blood loss, RIRS group less than group PCNL, there was statistically significant difference (P<0.05). (iii) Postoperative condition: stomach intestine functional recovery after the operation of group RIRS was earlier than group PCNL, there was statistically significant difference (P<0.05). Postoperative patients’ out-of-bed activity time and average day in hospital of group RIRS were less than group PCNL, comparing differences between the two groups have statistical significance (P<0.05). (iv) Adverse reactions: there were two cases of hyperpyrexia in group RIRS postoperative patients (temperature >39.0°), the anti-infection short-term improvement in discharged after symptomatic treatment. there also were two cases of hyperpyrexia in group PCNL postoperative patients (temperature >39.0°), the anti-infection short-term improvement in discharged after symptomatic treatment. One patient with bacteremia was recorded by positive anti-infection anti-shock symptomatic support hospital cured after treatment. One case of late-onset rebleeding after 12 hours, cured by DSA embolization before hospital discharge. (v) The postoperative visual analogue scale (VAS) pain scores. In 5 days after surgery, the difference between group RIRS and PCNL resting VAS pain scores was statistically significant (P<0.05), and group RIRS was obviously lower PCNL group in the activity of VAS pain scores (P<0.05). Two groups of patients with resting VAS pain score is lower than activity VAS pain scores (P<0.05). (II) inflammatory reaction. (i) Comparison in the group: compared with preoperative, IL-6, IL-10, Cor, WBC was elevated obviously and reach peak in postoperative day 1, through a slight decline, it had a basic return to normal level in postoperative day 5. CRP was elevated obviously in postoperative 1 hour, peak appears in the day 1, and was still higher than normal till day 5. (ii) Comparison between groups: all preoperative indicators had no significant difference between two groups; the increased stress indexes level of group RIRS in 1 hour after operation, postoperative day 1, 3, 5 was less than group PCNL, there was an obvious difference of statistical significance.ConclusionsSurgical trauma can cause the release of inflammatory factor increases, the anti-inflammatory cytokine secretion will also increase. Compare with percutaneous nephroscopy lithotripsy, flexible ureteroscope lithotripsy which would cause inflammatory reaction of body while treating renal calculi diseases is lower. It also had a lower incidence of adverse reactions after surgery and a faster postoperative recovery.

Protective effects of the aqueous extract of Crocus sativus against ethylene glycol induced nephrolithiasis in rats.

This study evaluated the possible protective effect of Crocus sativus L. (saffron) in the treatment of renal calculi. Aqueous extract of saffron (25, 50 and 100 mg/kg, daily) was administered intraperitoneally in two regimens of protective or curative, using male Wistar rats. Urolithiasis was induced by ethylene glycol (% 0.75) in drinking water. Urine was collected for biochemical analysis and the kidneys were prepared for total lipid peroxide and histological evaluation. Ethylene glycol feeding resulted in an increased urine output, renal excretion of oxalate and decreased excretion of citrate and magnesium. Saffron did not show diuretic effect; however, it significantly reduced the elevated urinary oxalate in prophylactic (50 and 100 mg/kg) and curative (100 mg/kg) studies. Only the high dose of prophylactic regimen restored citrate concentration of urine. Increased number of calcium oxalate crystals deposits in the kidney tissue of calculogenic rats was significantly reverted by the prophylactic and high dose of curative saffron treatment. Malondialdehyde (MDA, a lipid peroxidation product) in the kidneys was increased following the lithogenic treatment; however, prophylactic (50, 100 mg/kg) and curative (100 mg/kg) regimens with saffron reduced the elevated levels of MDA. Results in the current study indicate that saffron can protect against ethylene glycol induced calcium oxalate (CaOx) nephrolithiasis. The mechanisms underlying this effect are mediated possibly through effect on the urinary concentration of stone-forming constituents and an antioxidant effect.

Comparison of efficacy and safety between flexible ureteroscope lithtripsy and percutaneous nephrolithotomy for renal calculus

Objective To compare the safety and efficacy between flexible ureteroscope lithtripsy (FURL) and percutaneous nephrolithotomy (PCNL) in treating the renal calculus.Methods From Jan.2012 to Oct.2013,120 male and 87 female patients with renal calculus were accepted FURL (n =108)or PCNL (n=99) in our hospital.In FURL group,108 cases were classified according to the diameter of the stone,including 33 patients with the diameter of renal stone more than 20mm (range 20-39 mm,mean 29.2±5.6 mm)and 75 patients with the diameter of renal stone less than 20 mm (range 13-19 mm,mean 16.8± 1.3 mm).In PCNL group,99 cases were also classified according to the diameter of the stone,including 51 patients with the diameter of renal stone more than 20 mm (range 20-45 mm,mean 30.4±6.6 mm)and 48 patients with the diameter of renal stone less than 20 mm (range 14-19 mm,mean 17.2±1.4mm).There were no significant differences between the groups FURL and PCNL in the stone size(P＞0.05).Demographic data,operative duration,postoperative hospital stay,complication rate,and stone-free rate were recorded and compared.Results The overall stone free rate in group FURL was significantly lower 80.6％ (87/108) than that in group PCNL 91.9％ (91/99) (P＜0.05).In those patients with the diameter of stones less than 20 mm,the stone free rate was 88.0％ (66/75) in group FURL vs 93.8％ (45/48) in group PCNL (P＞0.05).The operative time was 30-65 (mean 49.5±6.9) min and 30-65 (mean 46.9±7.2) min in FURL and PCNL group,respectively (P＞0.05).In those patients with the diameter of stones more than 20 mm,the stone free rate was 63.6％ (21/33) in group FURL,which was lower than that in group PCNL 90.2％ (46/51) (P＜0.05).The operative time was 60-115 min (85.0±16.3) min and 30-95 min (68.3± 16.7) min in FURL and PCNL group,respectively (P＜0.05).The overall complication rate was significantly lower in group FURL 2.8％ (3/108) compared to group PCNL 8.1％ (8/99) (P＜0.05).Postoperative hospitalization stay were 2-6 d (3.5±1.4) d and 3-9 d (5.8±1.9) d in FURL and PCNL group,respectively (P＜0.05).Conclusions Both PCNL and FURS are efficacy and safe surgical alteration for patients with renal calculus.As to the FURS,its merits were faster recovery,less invasiveness than those in PCNL.Therefore,it can be considered as the first-line treatment for renal calculus ＜20 mm.However,for renal calculus ≥20 mm stones,FURS is still effective. Key words: Renal calculus; Flexible ureteroscope; Percutaneous nephrolithotomy; Safety; Effectivity

Antiurolithiatic Activity of Crashcal on Ethylene Glycol Induced Urolithiasis in Rats

The present study was designed to evaluate effect of Crashcal, a polyherbal formulation in the treatment of renal calculi. The urolithiasis was induced by ethylene glycol. Male Wistar rats (150–200 g) were selected and divided into seven groups. Ethylene glycol (0.75%) in drinking water was fed to all groups except normal group (Group–1) till 28th day to induce calculi. Group–4 and Group–5 served as preventive regimen (PR) and Group–6 and Group–7 served as curative regimen (CR) and were treated with different doses of Crashcal. Group–1, 2 and 3 served as normal,calculi induced and standard (cystone 750 mg/kg) respectively. Oxalate, calcium and phosphates were monitored in the urine and kidney. Serum BUN, creatinine and uric acid were also recorded. In-vivo antioxidant parameters such as lipid peroxidation (MDA), glutathione (GSH) and superoxide dismutase (SOD), catalase (CAT), body weight, kidney weight and urine volume were also monitored. In hypercalculi animals, the oxalate, calcium and phosphate excretion grossly increased. However, the increased deposition of stone forming constituents was significantly lowered by Crashcal. It was also observed that Crashcal produced significant decrease in MDA and increased GSH, SOD and CAT. The present study suggests that Crashcal possess significant antiurolithiatic and antioxidant activity in rats.

923 Prospective study on outcomes of retrograde intrarenal surgery (RIRS) in the treatment of renal calculi between 2 & 3cm

923 Prospective study on outcomes of retrograde intrarenal surgery (RIRS) in the treatment of renal calculi between 2 & 3cm

MP73-10 AFTER EMERGENT DRAINAGE OF AN OBSTRUCTED KIDNEY BY A DOUBLE J STENT; DOES URETEROSCOPIC STONE EXTRACTION IS ALWAYS NEEDED?

INTRODUCTION AND OBJECTIVES: Endoscopic treatment of renal calculi relies on surgeon assessment of residual stone fragment size for either basket removal or for the passage of fragments postoperatively. We therefore sought to determine the accuracy of endoscopic assessment of renal calculi size. METHODS: Five board certified endourologists participated in an ex vivo artificial endoscopic simulation. A total of 10 pebbles were measured (mm) by non-participating urologist (NDP) with electronic calibers and placed into separate labeled opaque test tubes to prevent visualization of the stones through the side of the tube. Endourologists were blinded to the actual size of the stones. A flexible digital ureteroscope with a 200-micron core sized laser fiber in the working channel as a size reference was placed thru the ureteroscope into the test tube to estimate the stone size (mm). Accuracy was determined by obtaining correlation coefficient (r) and constructing an AltmanBland plot. RESULTS: Endourologists tended to overestimate actual stone size by a margin of 0.05 mm. The Pearson correlation coefficient was r1⁄4 0.924, with a p-value < 0.01. Altman-bland plot analysis suggests that surgeons are able to accurately estimate stone size within a range of -1.8 to + 1.9 mm. CONCLUSIONS: This ex-vivo simulation study demonstrates that endoscopic assessment is reliable when assessing stone size. On average, there was a slight tendency to over-estimate stone size by 0.05 mm. Most endourologists could visually estimate stone size within -1.8 to +1.9 mm of the actual size. These findings could be generalized to state that endourologists are accurately able to assess residual stone fragment size intra-operatively to guide decision-making.