Prospective observational study on the prognosis of ureteral lesions caused by impacted stones via dual-energy spectral computed tomography

Objective Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture.On this basis,the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture.Methods This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019.They underwent an abdominal scan on a dual-energy spectral computed tomography.During surgery,the operator used ureteroscopy to identify ureteral lesions,which were classified into four categories:edema,polyps,pallor,and hardening.Seven months later,90 patients were reviewed for the degree of hydronephrosis.Results Endoscopic observations revealed 38(41%)cases of ureteral edema,20(22%)cases of polyps,13(14%)cases of pallor,and 22(24%)cases of hardening.There were significant differences in hydronephrosis,the period of impaction,the calcium concentration of the ureter,and the slope of the spectral Hounsfield unit curve between the four groups.After that,we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening.Receiver operating characteristic curve analysis showed that 5.3 mg/cm^(3)calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening.The result of follow-up showed that 80 patients had complete remission of hydronephrosis,with a complete remission rate of 61.9%(13/21)in the hardening group and 97.1%(67/69)in the non-hardening group(p<0.001).Conclusion Calcium concentration of the ureter is an independent predictor of ureteral hardening.Patients with ureteral hardening have more severe hydronephrosis after ureteroscopic lithotripsy.When the calcium concentration of the ureter is less than 5.3 mg/cm^(3),ureteral lesions should be actively treated.

Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones

Background Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones.Methods From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2.Results In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket （51.6%）. Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%.Conclusions Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope.

Value of urine IL-8, NGAL and KIM-1 for the early diagnosis of acute kidney injury in patients with ureteroscopic lithotripsy related urosepsis

Purpose::To investigate the clinical value of urine interleukin-18(IL-8),neutrophil gelatinase-associated lipocalin(NGAL)and kidney injury molecule-1(KIM-1)for the early diagnosis of acute kidney injury(AKI)in patients with ureteroscopic lithotripsy(URL)related urosepsis.Methods::A retrospective study was carried out in 157 patients with urosepsis after URL.The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8,NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0,4,12,24 and 48 h after the surgery.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.Results::The level of urine IL-8,NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4,12,24 and 48 h(p<0.01).The ROC analysis showed the combined detection of urine IL-8,NGAL and KIM-1 at 12 h had a larger area under curve(AUC)than a single marker(0.997,95%CI:0.991-0.998),and the sensitivity and specificity were 98.2%and 96.7%,respectively.Pearson correlation analysis showed that the levels of urine NGAL at 4,12,24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18(p<0.01).Conclusion::AKI could be quickly recognized by the elevated level of urine IL-8,NGAL and KIM-1 in patients with URL-related urosepsis.Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance,which may be an important reference for the early diagnosis of AKI.