Treatment Of Upper Ureteral Calculi Research Articles

A simple predictive model with internal validation for assessment of stone-left after ureteroscopic lithotripsy in upper ureteral stones.

BackgroundStone free rate in upper ureteral stones is not as high. We sought to identify easily accessible risk factors attributing to stones left in the ureteroscopy in the treatment of upper ureteral calculi, and to build a simple and reliable predictive model.MethodsPatients treating only for upper ureteral stones in 2018 were retrospectively analyzed. Correlations between factors and the stone free rate were analyzed using bidirectional stepwise regression, curve fitting and binary logistic regression. Stone shape was judged by the gap between length and width in the two-dimensional section. A predictive nomogram model was built based on those selected variables (P<0.05). The area under the receiver operator characteristic curve (AUC) and calibration curve were used to access its discrimination and calibration. Decision curve analysis (DCA) was conducted to test the clinical usefulness.ResultsTotally, 275 patients with 284 stones were enrolled in this research. Bidirectional stepwise regression showed that stone length had a significant effect on stone free, instead of width or burden. Stone shapes were also found playing a big role. Curve fitting showed that quasi-circular stones had a high risk of retropulsion, and eventually led to stone left. Finally, stone length, shape, modality, and the distance of stones to the ureteropelvic junction were enrolled in the model. Among them, the distance of the stone to the ureteropelvic junction showed a noticeable impact on stone left. AUC was 0.803 (95% CI: 0.730–0.876), and the calibration curve showed good calibration of the model (concordance index, 0.792). DCA indicated the model added net benefit to patients.ConclusionsThe present predictive model based on those factors, stones length, shape, modality, and distance of the stone to the ureteropelvic junction was easy, reliable and useful.

MP081 - Comparison of pneumatic lithotripsy versus laser lithotripsy for treatment of upper ureteral calculi

MP081 - Comparison of pneumatic lithotripsy versus laser lithotripsy for treatment of upper ureteral calculi

Clinical Analysis of the Efficacy and Safety of Two Different Surgical Methods in the Treatment of Upper Ureteral Calculi with Diameter ≤2cm

Clinical Analysis of the Efficacy and Safety of Two Different Surgical Methods in the Treatment of Upper Ureteral Calculi with Diameter ≤2cm

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

To investigate the clinical efficacy of a novel vacuum suction ureteroscopic approach in the treatment of upper ureteral calculi and to compare it with traditional rigid and flexible ureteroscopic approaches. A total of 160 patients with impacted upper ureteral calculi were included in this study. 50 patients underwent rigid ureteroscopic lithotripsy, 54 patients underwent flexible ureteroscopic lithotripsy, and 56 patients underwent vacuum suction ureteroscopic lithotripsy. The operative time, length of hospitalization, stone-free rate, the incidence of postoperative complications, and total treatment cost were compared among the three groups. Subgroup analysis was performed based on the stone diameter over and below 1.5 cm. All operations were performed successfully, and there were no cases converted to open surgery. Compared with the other 2 groups, the vacuum suction ureteroscopy group had a higher stone-free rate at 3-5 days (90.0% vs. 61.9% vs. 55.6%, P < 0.05) and 1 month (96.4% vs. 77.7% vs. 74.0%, P < 0.05) postoperatively. In subgroup analysis, the stone-free rate of the vacuum suction ureteroscopy group was significantly higher when the stone diameter was > 1.5 cm at 1 month postoperatively (P < 0.05) compared with that in the other 2 groups; however, there were no differences in postoperative complications. (P > 0.05). The novel vacuum suction ureteroscopic lithotripsy has significantly improved the stone-free rate especially in complicated cases, compared with that in rigid and flexible approaches; however, the complication and cost were not increased.

Evaluation of ureterorenoscopy with semirigid ureteroscope and laser lithotripsy as a treatment modality for upper ureteric stones less than 20 mm

Context: Technological developments over the past two decades have revolutionized the treatment of ureteric stones. With the emergence of flexible, small-diameter ureteroscopy, the paradigm of ureteral stone treatment has shifted to ureteroscopy. The success rate is close to 95%, but it has its own complications. Objective: The objective of this study is to assess the effectiveness of ureterorenoscopy (URS) with semirigid ureteroscope and laser lithotripsy in the treatment of upper ureteric stones of size less than 20 mm and its associated complications. Methods: This is a prospective cohort study designed to assess the effectiveness of URS for the treatment of upper ureteric calculi. We present data from 57 patients who received URS as their primary treatment at our center and were followed up for at least 3 months. Results: We found that when stone size was less than 10 mm, the stone-free rate was 80% (28/35), while when stone size was in the 10.1–20 mm range, the stone-free rate increased to 90.9% (20/22). Stones were found in 41/48 patients (85.41%) with symptoms lasting less than a month. Only 7/9 patients (77.77%) were stone-free in the group with symptoms lasting more than a month. A total of 28.1% of patients encountered complications among which proximal migration of the stone was the most common (12.3%). Mean procedure time was 40.37 min. Conclusion: This study shows that URS had a higher stone-free rate when treating stones of size ranging from 10.1 to 20 mm. In upper ureteric stones ranging in size from 10.1 to 20 mm, we strongly advise using URS as the primary treatment option.

Comparative Analysis of Semi Rigid Ureterolithotripsy and Extracorporeal Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi

Objectives: To find out the better treatment option between semi rigid ureteroscopy with ICPL and ESWL for upper ureteric calculi. To compare stone free rate, complications and re treatment between ureterolithotripsy and ESWL in upper ureteric calculi. Materials and Method: This prospective comparative study was conducted in the department of urology BSMMU and Kidney and urology hospital, Dhaka from June 2009 to May 2010. Fifty patients were enrolled and 25 on each group as ESWL and ICPL Inclusion criteria was adult patients with single radiopaque stone of 06-15 mm, and no obstruction distal to stone. We exclude Stone size &gt; 1.5cm, PUJ stone, patients with DJ stent and nephrostomies, infection, pregnancy, hemostatic, disorders, and morbid obesity. Identified postoperative urological complications pain, haematuria, fever, stone migration, obstruction, infections, and postoperative hospital stays recorded accordingly. X- ray KUB and in some cases ultrasound of kidney ureter and bladder with prostate with PVR were done. Those with residual calculi sized less than 2 mm were considered stone free. Those patients whom stone not cleared or stone migrated they again sent for ESWL or ureterolithotripsy. Stone free patient of ureterolithotripsy sent for removal of Double J stent under local anesthesia at 4 weeks. Results: Three months postoperatively, 21 out of 25 Patients (85%) in the ureterolithotripsy group were stone free. In ureterolithotripsy group, all failures were due to upward calculus migration. After calculus migration, this was mandated double- J stenting and send for ESWL. These patients were referred for ESWL, all of whom were stone free after this procedure. DJ stent removed under local anesthesia. 22 out of 25 Patients (88%) in the ESWL group were stone free and 10 patients need two sessions. Re-ESWL had done after 3 weeks. All failures in ESWL group were due to hard in constancy and small stone size. Failed cases were referred for ureterolithotripsy and DJ stenting, all of whom were stone free after this procedure. Using statistical data by chi square test and analytical test level of significance as set at 0.05 and p&lt; 0.05 was consider significant. Conclusion: Upper ureteral calculi up to 1.5 cm can be safely and effectively managed by using semi rigid ureteroscopy and pneumatic lithotripsy. However, the ESWL approach has still its role in treating upper ureteric calculi. Finally, postoperative home rest in the ESWL group was more due to the repeated treatment. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.54-60

Outcome of Semi-rigid Ureteroscopy with LASER Lithotripsy for Management of Upper Ureteric Calculi

Background: Proximal ureteral calculi are common with multi-modalities of treatment, with continuous invention of new modalities. Aim of the work: To present the early experience with LASER lithotripsy using semi-rigid ureteroscopy for treatment of upper ureteral calculi, regarding safety and efficacy. Patients and Methods:Eighty patients with upper ureteral stones managed by LASER lithotripsy using semi-rigid ureteroscopy were included [30 prospective and 50 retrospective]. Patient evaluation included medical history, clinical examination with preoperative laboratory and radiological investigations. The outcome measure was stone free rate, Intra operative and Postoperative complications, operative time, hospitalization time, and post-operative analgesia. Results: During the period from January 2018 through February 2020 in 30 prospective cases but retrospectively in 50 cases done in the last two years, 68.8% of patients were males and 31.2% of them were females, mean of age was 43.70 with range from 20 to 66 years, and mean of BMI was 19.75 with range from 18 to 23 with laterality of 60% of patients was right but of 40% was left and stone opacity of 96.25% of patients was radio opaque, while, 3.75% was radio lucent stones the mean operative time was 50.78 minutes and mean duration of hospital stay was 1.3 days. In addition, 66.2% of patient needed JJ, 32.5% required ureteric catheter and 15% failed ESWL. The mean ureteral stone diameter was 10.81. The clearance rate 97.5%; two cases had migrated stone. Conclusion: Semirigid ureteroscope with LASER lithotripsy is an effective and safe procedure for management of large proximal ureteral stones with a lesser rate of stone migration needs use of flexible ureterorenoscopy.

A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

Introduction: There are various international guidelines for the surgical treatment of upper ureteral calculi. For upper ureteral stone of less than 10 mm size, ESWL and URS are regarded as first line treatment. However, there is lack of national guidelines for appropriate surgical options for such stone in our settings.&#x0D; Methods: The study was prospective comparative type involving 100 patients who were divided into ESWL and URS groups comprising 50 patients in each. ESWL and URS were performed after confirmation of stone size with ultrasonography and non-contrast enhanced computed tomography. All patients underwent X-ray KUB at one week and six weeks post procedure for confirmation of stone clearance. Those with residual calculi of size &lt; 5 mm were considered stone free. Statistical analysis was done using Graph pad prism version 6. &#x0D; Results: The mean age of patients in ESWL and URS groups were 41.28 ± 15.3 years and 42.84 ± 16.1 years respectively. The male to female ratio was higher in ESWL group. The mean size of the stone pre ESWL was 8.58 mm and pre URS was 8.44 mm. The percentage of stone clearance at one week and six weeks for ESWL was 56% and 90% respectively whereas for URS, it was more than 90% at both one week and six weeks. The complications were higher with URS (20%) than ESWL (8%).&#x0D; Conclusions: The ESWL and URS are equally effective in stone clearance. The duration is longer with ESWL and the complications were more in URS group.

Comparison of occluder combined with ureteroscopy and microchannel percutaneous nephrolithotomy in the treatment of upper ureteral calculi

Objective To compare the efficacy of occluder combined with ureteroscopic lithotripsy(URL) and minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of upper ureteral calculi. Methods Retrospective analysis of 80 patients with upper ureteral calculi from January 2015 to October 2016 in our hospital, including URL in 40 cases of occlusion device (combination group), MPCNL group of 40 cases was performed. The success rate of disposable lithotripsy, stone clearance after 1 month, incidence of surgical complications, and time of surgery and hospitalization were compared between the two surgical groups. Results The success rate of disposable lithotripsy: 87.5%(35/40) in the combined treatment group, 97.5% (39/40) in the MPCNL treatment group, and stone clearance rate after 1 month: the combined treatment group 97.1%(34/35), 97.4%(38/39) of the MPCNL treatment group, the difference was not statistically significant(P>0.05). Surgery and hospital stay: operation time(43.3±13.6)min, hospitalization time(5.2±1.5)d, MPCNL operation time(65.4±14.5)min, hospitalization time(8.4±2.1)d, the difference was statistically significant(P 0.05). Conclusions The ureteral occlusion device combined with ureteroscopy and MPCNL are reliable surgical methods for the treatment of upper ureteral calculi. Key words: Ureteral Calculi; Ureteral occlusion device; Ureteroscopy; Nephrostomy, Percutaneous

Comparison of the effect of intercepting basket or occluder and non-occluder in the operation of upper ureteral calculi

Objective To study the effect of intercepting basket or occluder and non-occlusion device in the operation of upper ureteral calculi. Methods A total of 90 patients underwent ureteral calculi from February 2015 to February 2017 were randomly divided into control group, occluder group and basket group. The control group did not use the blocking device, the occluder group using N-Trap intercept network, the basket group using the British Connaught occluder. Comparison of the three groups of stone clearance rate, the success rate of disposable gravel, stone uptake rate, the incidence of complications, operation time, postoperative hospital stay was performed. Results The success rate of the lithotripsy rate and the disposable gravel were significantly higher in the occluder group and the basket group than in the control group, the difference was statistically significant (P 0.05). The incidence of complications and the incidence of complications were slightly lower than those of the control group (P 0.05). The time of operation and the time of hospitalization were shorter than those of the control group, the difference was statistically significant (P 0.05). Conclusions Interventional basket or occluder is effective in the treatment of upper ureteral calculi with ureteroscopic holmium laser lithotripsy, which can effectively improve the rate of stone and the success rate of disposable crushed stone, reduce the occurrence of calculus and complication, promote the early rehabilitation of patients, clinical patients can choose according to the actual situation of the device. Key words: Ureteral Calculi; Ureteroscopy

Analysis of the influence of ureteroscopic pneumatic lithotripsy on the serum levels of CRP, IL-1 and TNF-αin patients with upper ureteral calculi

Objective To investigate the therapeutic effect of ureteroscopic pneumatic lithotripsy (URSL) on ureteral calculi and the effect on serum CRP, IL-1, TNF-αlevels. Methods Retrospective analysis of clinical data of patients with upper ureteral calculi from February 2015 to October 2016 in our hospital was performed. All patients were divided into ureteroscopy lithotripsy group (URSL group) and percutaneous nephrolithotomy group.The general situation of the two groups were observed. The levels of serum inflammatory factors, urinary function and quality of life were compared between the two groups before and after operation. Results The operation time and hematuria time of URSL group were shorter than those of percutaneous nephrolithotomy (t=27.415, 12.018, P<0.001). The stone free rate was higher than that in the percutaneous nephrolithotomy group.The level of inflammatory factors in the two groups had no difference before treatment, after treatment, the level of CRP, TNF-α, NF-κB alpha and IL-1 of the URSL group were lower than those of percutaneous nephrolithotomy group. The IPSS score of patients in URSL group was lower than that of percutaneous nephrolithotomy group at 1 month and 3 months after operation, and Qmax was higher than that of percutaneous nephrolithotomy group.There was no difference in quality of life between the two groups before operation. After operation, the quality of life score of URSL group was higher than that of percutaneous nephrolithotomy group in the 3 months after operation. Conclusions URSL has a good effect on the treatment of upper ureteral calculi, it can reduce postoperative serum CRP, IL-1, TNF-αlevel, im- prove the quality of life. Key words: Ureteral Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Calcitonin Gene-Related Peptide; Interleukin-1; Tumor Necrosis Factor-alpha

Guide sheath-assisted ureteroscope lithotripsy for upper ureteral calculi: An observational study on 81 cases.

The present study assessed the clinical efficacy of guide sheath-assisted ureteroscope lithotripsy in the treatment of upper ureteral calculi. A total of 81 patients with upper ureteral calculi underwent ureteroscope lithotripsy assisted by a guide sheath between January 2012 and June 2014; of these, 63 patients were successfully treated with simple rigid ureteroscope lithotripsy assisted by a ureteral access sheath, and 18 patients were successfully treated with rigid and flexible ureteroscope lithotripsy assisted by a guide sheath. At 1 day after the surgery, ultrasound examination of kidneys, ureters and bladder, and urinary system computed tomography were used to re-check for residual stones, and 69 patients had stones with a diameter of <2 mm in the renal pelvis, while 12 had stones of 2–4 mm in diameter. The operation time was 30–115 min (average, 56.0±4.8 min); all patients underwent a successful surgical procedure. A total of 7 patients had an elevated temperature 37.4–39.1°C (mean temperature, 37.7±0.3°C) after the surgery, but no other major complications were noted. After 1 month, the residual stones were completely discharged, so that the stone clearance rate was 100%. All patients were followed up for 3–12 months and no associated complications occurred. Overall, ureteroscope lithotripsy assisted by a guide sheath for the treatment of upper ureteral calculi had the benefit of water injection and reflux functions, as well as enhanced vision, reduced pressure within the renal pelvis, good discharge of stones as well as an improved efficiency and success rate compared with simple ureteroscopic lithotripsy.

A clinical study of four kinds of laparoscopic treatment for the upper ureteral calculi with diameter more than 1 cm

Objective To analyze the four types of laparoscopic operation in the treatment of upper ureteral calculi with diameter more than 1cm. Methods From July 2012 to September 2015, 150 cases of patients with upper ureteral calculi diameter more than 1cm were analyzed. According to the different surgical methods, patients were divided into four groups. There are 39 cases in URL group, 32 cases in RLU group, 36 cases in PCNL group and 43 cases in FURL group. The diameter of calculi in RLU group and PCNL group was much larger than those in URL group and FURL group(P 0.05). The operation time, postoperative hospitalization days, postoperative bowel recovery, postoperative ESWL rate, complications and postoperative calculi clearance rate were compared among the four groups. Results In RLU , PCNL , URL and FURL group, the operation time were (38.5±13.0)min, (83.4±6.1)min, (69.6±13.0)min and(50.1±6.3)min, respectively, and there were significant differences among the four groups (RLU group>PCNL group>FURL group>URL group, P PCNL group>FURL group>URL group, P 0.05). Postoperative ESWL rates of RLU group, PCNL group, URL group and FURL group were 12.8%, 0, 2.8% and 4.7% , and there was no difference among the four groups. The decreased value of RBC in PCNL group and FURL group was higher than that of URL group and RLU group(P 0.05). Conclusions Four types of endoscopes have the advantages of safety, small wound and quick recovery for ureter calculi larger than 1 cm . The URL operation is simple, with less injury, quick recovery, but low stone clearance rate. FURL requires high level of skill for the operator, and is an effective treatment for ureteric, renal pelvic, and kidney stones which are smaller than 2 cm. FURL avoids the extra ESWL treatment, but costs much. PCNL has more injury and requires high-level surgical skills with a high stone clearance rate. RLU has a high stone clearance rate but is much difficult, which can be used as a remedy for the failure of FURL or PCNL. Key words: Ureteral calculi; Laparoscopy; Ureteroscope; Percutaneous nephrolithotomy

In Situ Extracorporeal Shock Wave Lithotripsy (ESWL) and ESWL after Push Back For Upper Ureteric Calculi: A Comparative Study

Background: ESWL is one of the most important modality for the treatment of urolithiasis. In situ ESWL is a non-invasive and safe procedure for renal and upper ureteric stones in selected cases &amp; can be performed on outpatient basis. However, some urologists claim a higher success rate of ESWL after push back procedures for upper ureteric calculi.Materials &amp; Methods: This prospective study was done to compare the results of treatment of upper ureteral calculi by in situ ESWL and ESWL after push back. 90 consenting patients with single upper ureteric stones of ≤ 1 cm in size with no distal obstruction were selected and divided into two groups. 50 patients in group 1 were treated by in situ ESWL while 40 patients in group 2 were treated by push back followed by ESWL.Results: Better clearance was achieved with ESWL after push back (92.5% clearance after 90 days) than with in situ ESWL (90% clearance after 90 days) but it was not statistically significant (p&gt;0.05). The mean shock wave was 1994 ± 449 for in situ ESWL group and 1757.5 ± 255 for ESWL after push back group, which was statistically very significant (p&lt;0.01). The mean energy used was 5.07 ± 0.81 in the in situ ESWL group and 4.6 ± 0.48 in ESWL after push back group and this difference was also statistically significant (p&lt;0.01). Post procedure complications like loin pain, hematuria, lower urinary tract symptoms (LUTS) and fever were more common in ESWL after push back group than in the in situ ESWL group and the differences were statistically significant.Conclusion: In situ ESWL is a better option than ESWL after push back for the management of upper ureteric stones in selected group of patients. Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), page: 72-76

Comparative study of intercepting basket and non-plugging device in the treatment of upper ureteral calculi in operation

Objective To explore the application value of intercepting basket in the treatment of upper ureteral calculi in operation. Methods One hundred and twenty-six cases patients with upper ureteral calculi who were treated in Songgang People′s Hospital of Bao′an District of Shenzhen from December 2012 to December 2015 were included and randomly divided into Group A and Group B, 63 cases in each group.Group A were treated with NTrap intercepting basket combined with ureteroscope holmium laser lithotripsy, while Group B were treated with holmium laser lithotripsy solely without intercepting basket.The operation situation, postoperative recovery, therapeutic efficacy and safety of two groups were observed. Results The time of surgery, time of postoperative hematuria and postoperative hospitalization time in Group A were (49.56±7.45) min, (1.47±0.67) d and (3.11±0.96) d respectively, in Group B were (51.37±7.39) min, (1.59±0.63) d and (3.37±0.85) d respectively, there were no significant differences in those indexes between two groups(t=1.369, 0.518, 1.609; P=0.173, 0.606, 0.110). The stone upward displacement rate of Group A and Group B were 3.17%(2/63) and 23.81%(15/63) respectively, of Group A was significantly lower and the difference was significant(χ2=11.492, P=0.000). The gravel success rate and postoperative 4 weeks clearance rate of Group A were 95.24%(60/63) and 98.41%(62/63) respectively, significantly higher than that of Group B(74.60%(47/63), 82.54%(52/63)), the difference was statistically significant(χ2=10.474, 9.211; P=0.001, 0.002). The postoperative complication rate of Group A and B were 6.35%(4/63) and 11.11%(7/63) respectively, there was no significant difference between the two groups(χ2=0.896, P=1.421). Conclusion Application of intercepting basket in the treatment of upper ureteral calculi in operation has exact effect for the prevention of stone and stone upward displacement, can significantly improve the successful rate of lithotripsy and stone clearance rate, it is worthy of promotion. Key words: Ureteral calculi; NTrap basket; Upward displacement; Clinical effect

Extraction basket in ureteroscope holmium laser lithotripsy for upper ureteral calculi

Objectives To investigate the clinical application value of ureteroscope holmium laser lithotripsy with NGage extraction basket in the treatment of upper ureteral calculi. Methods Totally 80 patients with upper ureteral calculi were randomly divided into two groups, 40 patients in control group were treated by ureteroscope holmium laser lithotripsy, 40 patients in observation group were treated by ureteroscope holmium laser lithotripsy combined with NGage extraction basket. Results The success rate of primary lithotripsy in observation group were 95%, which was higher than that in control group(75%), and the difference was statistically significant(P<0.05). The rate of residual calculi in observation group were 5%, which was lower than that in control group(20%), and the difference was statistically significant(P<0.05). There was no significant difference between two groups in the operation time, complication rate and hospitalization time. Conclusions NGage extraction basket with ureteroscope holmium laser lithotripsy could efficaciously prevent calculi from moving upward in the treatment of upper ureteral calculi, which could achieve higher success rate and lower residual calculi rate. Key words: Ureteral Calculi; Ureteroscopes; Lithotripsy, Laser

Comparison of ureteroscopic lithotripsy and mini–percutaneous nephrolithotomy for the treatment of upper ureteral calculi

Objectives To observe and compare the clinical effect of ureteroscopic lithotripsy(URS) and mini–percutaneous nephrolithotomy(MPCNL) for the treatment of upper ureteral calculi. Methods 200 cases of patients with upper ureteral calculi in our hospital from September 2012 to January 2015 were collected. And all patients were randomly divided into the study group group(103 cases)and the control group(97cases). The patients in the control group were treated with MPCNL, while the study group's patients were given URS. The operation time, operation success rate, postoperative hemoglobin decrease, postoperative pain, stone clearance rate, postoperative complications, hospitalization time, treatment costs were compared between the two groups. Results The operation time of the study group was slightly longer than that of the control group, and the removal rate of initial stones was lower than that of control group(P 0.05). Conclusions The removal rate of URS is almost equal to MPCNL, and URS has the advantages of less pain, rapid recovery and low operation costs. Key words: Ureteral Calculi; Ureteroscopes; Lithotripsy, Laser; Nephrostomy, Percutaneous

Study on tubeless mini-percutaneous nephrolithotomy in treatment of the upper ureteral calculi

Objective To investigate the feasibility and clinical effect of the tubeless mini-percutaneous nephrolithotomy (PCNL) in treatment of upper ureteral calculi. Methods From March 2014 to March 2015, all the patients with upper ureteral calculi except for those with severe infection, pyonephrosis or renal cortex less than 5 mm were randomized into two groups, the standard PCNL group (24 F nephrostomy tube) and the mini-PCNL group (18 F nephrostomy tube). After PCNL, all the patients received ultrasound examination to check residual stones, perforation and urine leakage. DJ tube was placed and the channel of PCNL was packed with hemostatic sponge without nephrostomy tube. There were 26 patients in standard group and 28 in mini-group. The operation time, postoperative hemoglobin change, postoperative visual analogue pain score (VAS), the time when urine turned clean, postoperative urinary extravasation, hydrothorax, fever and the stone-free rate were compared between two groups. Particularly, these data were compared in those aged>65 years. Results The operation time in the standard PCNL and the mini-PCNL group was (58.3±21.8) and (86.4±23.3) minutes respectively, and had a significant difference (t=10.836, P 0.05). No significant difference were found between two groups (all P>0.05). There was one patient who got fever more than 38.5℃ in the standard group and 2 cases in the mini-group. Each group had 1 slight hydrothorax, and no blood infusion and perinephric urinary extravasation were found. The application of packing hemostatic sponge in the nephrostomy channel was feasible and suitable for both the standard and tubeless mini-PCNL groups. Conclusions The application of packing hemostatic sponge in the nephrostomy channel is feasible and suitable in both the standard and tubeless mini-PCNL. It is safe for the treatment of renal and ureteral calculi, and it can decrease the hemorrhage and urine leakage, which works for the elderly patients too. Key words: Percutaneous nephrolithotomy; Ureteral calculi

Efficacy of tamsulosin in treatment of upper ureteral calculi: a meta-analysis

Objective To systematically revise the efficacy and safety of tamsulosin in treatment of proximal ureteral calculi.Methods Electronic search was conducted with PubMed,Cochrane library,EMBASE,Wanfang database,CNKI and VIP to collect randomized controlled trials(RCTs) involving the application of tamsulosin in treatment of upper ureteral calculi.The quality of the included trials was assessed;the data were extracted and analyzed with RevMan 5.0 software.Results Five RCTs involving 480 patients were identified.The results of meta-analysis showed that,compared with the control group,patients in the tamsulosin group had(1) a remarkably higher stone clearance rate(RR=1.25,95%CI:1.12-1.40,P0.000 1),(2) shorter mean time of calculi expulsion(shortened by 2.99 days,95%CI:-3.61——2.37,P0.000 01),and(3) decreased incidence of renal colic episodes and mean visual analogue scale pain score(RR=0.39,95%CI:0.26-0.57,P0.000 01;WMD=-10.94,95%CI:-21.30——0.58,P=0.04).Conclusion Our results show that tamsulosin can improve the stone clearance,shorten the mean time for calculi expulsion,decrease the incidence of renal colic episodes and the mean visual analogue scale pain score in patients with proximal ureteral calculi.

The clinical efficacy of retroperitoneal laparoscopic ureterolithotomy versus that of ureteroscopic pneumatic lithotripsy for upper ureteral calculi

Objective To compare the efficacy of retroperitoneal laparoscopic ureterolithotomy with that of ureteroscopic pneumatic lithotripsy for upper ureteral calculi,and provide clinical guidance for choices of treatment.Methods 112 patients who received treatment for upper ureteral calculi during the period of December 2009 to December 2010 in our hospital were randomly divided into two groups.Group A underwent retroperitoneal laparoscopic ureterolithotomy,while group B group received ureterescopic pneumatic lithotripsy.The efficacy of the two procedures and the related complications were compared between the two groups.Results The success rate of the procedure was significantly higher in group A ( 92.86％ ) than in group B ( 62.5％ ),with a statistical significance ( P＜ 0.05 ).The rate of intraoperative or postoperative complications did not differ statistically between the two groups ( P ＞ 0.05 ).Conclusions Retroperitoneal laparoscopic ureterolithotomy,as compared with ureteroscopic pneumatic lithotripsy,has a higher success rate,less surgical damage,rapid postoperative recovery,and no serious complications.It is worth popularizing clinically. Key words: Retroperitoneal laparoscopic ureterolithotomy; Ureteroscopic pneumatic lithotripsy; Upper ureteral calculi