Contemporary role of multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi

Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

An unusual case of renal calculi leading to myocardial infarction and cardiogenic shock

INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool extremities and altered mentation. The most common etiology of CS is acute myocardial infarction, Here, we report a case of a 42-year-old male who presented with right flank pain, nausea and vomiting initially thought to be nephrolithiasis, which he had a history of but was ultimately diagnosed with CS due to a type II myocardial infarction. This case illustrates the importance of having a broad differential diagnosis especially when a patient＇s vital signs take a drastic turn since this patient initially resembled someone with nephrolithiasis.

Comparison of the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus

Objective:To study the differences in the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus.Methods: A total of 78 patients with complex renal calculus who accepted surgical treatment in our hospital between May 2011 and January 2016 were collected, the operation methods and test results were reviewed, and then they were divided into the observation group (n=34) who accepted ultrasonic pneumatic treatment and the control group (n=44) who accepted holmium laser treatment.Ⅰstage stone clearance rate of two groups of patients were recorded;serum was collected, sarcosine oxidase method was used to detect serum renal function indexes, and ELISA method was used to detect the levels of inflammatory factors and stress hormones.Results: The mean lithotomy time of observation group was shorter than that of control group;differences inⅠstage stone clearance rate were not statistically significant between two groups of patients. 3 d after operation, serum renal function indexes Scr, BUN and CysC levels of observation group were lower than those of control group;serum inflammatory factors PCT, IL-1β, IL-22 and IL-13 levels of observation group were lower than those of control group while IL-4 level was higher than that of control group;serum stress hormones AngⅠ, AngⅡ, Adr and NE levels of observation group were lower than those of control group.Conclusion:Both ultrasonic pneumatic and holmium laser technology can effectively remove complex renal calculus and ultrasonic pneumatic technology has the advantages of quicker operation and less injury.

Study of Role of Magnetic Resonance Urography (MRU) and Comparison with Conventional Radiology in the Diagnosis of Complex Renal Anomalies: A Tertiary Care Centre Experience

Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional radiological investigations with magnetic resonance urography in the diagnosis of complex renal anomalies. Materials and methods: This was a prospective study done over a period of five years from 2006 to 2011. All the patients with suspected or diagnosed presence of renal anomalies were investigated by ultrasound (USG), Intravenous urography (IVU), micturating cystourethrogram (MCU), magnetic resonance urography (MRU), retrograde urethrography, cystogenitoscopy, renal scans as per the indication in the case. Results: Total sixty three patients were studied over the period. The most common complex renal anomaly diagnosed was duplex system and conventional radiological investigations were useful in the diagnosis of less than 50% patients. Female patients outnumbered male patients in having complex renal anomalies. MRU was diagnostic in most of the patients with such anomalies and excellent mode of investigation for functional and anatomical details. Conclusion: MRU is better than conventional radiological investigations in the diagnosis of complex renal anomalies.

Effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi

Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.

Comparative Observation on Nursing Effect of Nursing Intervention and Routine Nursing in Patients with Renal Calculi and Gastric Ulcer and the Impacts on Epidermal Growth Factor

Objective: To explore the comparative observation on nursing effect of nursing intervention and routine nursing in patients with renal calculi and gastric ulcer and the impacts on epidermal growth factor. Methods: A total of 72 patients with renal calculi and gastric ulcer were selected and treated in our hospital from January 2018 to December 2018. They were divided into the observation group and the control group, 36 for each. Comprehensive nursing intervention was implemented in the observation group, whereas routine nursing was implemented in the control group. The level of epidermal growth factor, nursing satisfaction, renal calculi recurrence rate, average hospital stay and postoperative blood loss were compared between the two groups after nursing. Results: There was no significant difference in the level of epidermal growth factor between the two groups before nursing (P > 0.05), while after nursing, the level in the observation group was higher compared with the control group, and the difference between the two groups was significant (P Conclusion: With regard to patients with renal calculi and gastric ulcer, comprehensive nursing intervention can improve nursing satisfaction and quality of patients’ lives, reduce calculi recurrence rate, and increase the level of epidermal growth factor, which has clinical application value.

Tuberous sclerosis complex associated renal clear cell carcinoma(a case report and literature review)

Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma. Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation pres-

Primary parenchymal squamous cell carcinoma of the kidney:A case report

BACKGROUND Primary squamous cell carcinoma(SCC)of the renal parenchyma is extremely rare,with only nine cases reported.CASE SUMMARY This study reports a 51-year-old man with primary SCC of the renal parenchyma.The patient was admitted with recurrent dull pain and discomfort in the right lumbar region,which had worsened over 2 weeks,accompanied by painful gross hematuria.SCC antigen(SCCA)levels were elevated,and imaging revealed a renal mass with associated calculi.The patient underwent laparoscopic unilateral nephrectomy and lymph node dissection.Postoperative pathology confirmed highly differentiated SCC with necrosis in the right renal parenchyma,with negative renal pelvis and ureter.The pathological stage was Pt3aN1M0.Four months after surgery,the tumor recurred with involvement of the liver,right psoas major muscle,and inferior vena cava.The patient refused chemotherapy and succumbed to the disease 6 months postoperatively due to disease progression.CONCLUSION We report a case of primary SCC of the renal parenchyma,a rare renal malignancy.The clinical symptoms,laboratory tests,and imaging findings are nonspecific,making accurate and timely diagnosis challenging.According to the literature,for patients with renal calculi accompanied by a renal mass,elevated serum SCCA levels,and magnetic resonance imaging showing cystic or cystic-solid masses within the kidney with pseudocapsules and heterogeneous mild enhancement,the possibility of this disease should be considered.

Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi

BACKGROUND Upper urinary tract stones are very common in my country,with an incidence of 1%to 5%in the North and an even higher incidence of 5%to 10%in the south.The incidence rate in the south is higher than that in the north,mainly due to the water quality,climate and eating habits of the region.From the perspective of sex,incidence is more likely in males than females.In the high-incidence population,young adults are most prone to stones.Men in the age range of 25 to 40 years are more likely to have stones.AIM To observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy(mPCNL)on upper urinary tract stones and its influence on the renal function of patients.METHODS Patients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method.The general conditions of the two groups of patients were observed during the perioperative period,and the differences in stone clearance,pain,renal function indicators and complication rates were compared between the two groups to determine which were statistically significant(P<0.05).RESULTS The operation time of the mPCNL group was longer than that of the PCNL group(t=-34.392,P<0.001),and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group(t=34.090,P<0.001).There was no difference in renal function indices between the two groups of patients before treatment,and there was no difference in the levels of serum creatinine,β2 microglobulin or retinol binding protein in the mPCNL group after treatment.The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group(t=12.191,P<0.001),and there was no significant difference in the stone clearance rate between the two groups(χ2 value=1.013,P=0.314).There was no significant difference in the incidence of urine extravasation,dyspnea and peripheral organ damage between the two groups(χ2 value=1.053,P=0.305).At 1 mo after treatment and 3 mo after treatment,the quality of life of the mPCNL group was lower than that of the PCNL group,and the Qmax level of the mPCNL group was higher than that of the PCNL group.CONCLUSION mPCNL has a good therapeutic effect on upper urinary tract stones,with a high stone clearance rate without causing kidney damage or increasing the incidence of complications,and thus has good application value.

Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain

BACKGROUND Urological calculi often cause renal colic,which is characterized by paroxysmal or persistent severe pain in the upper abdomen or lumbar region.Development of methods to quickly relieve these pain symptoms has garnered clinical attention.Wrist-ankle acupuncture is a type of floating acupuncture therapy administered at selected points in the carpal and ankle areas,and it has good pain-relieving effects.We used wrist-ankle acupuncture combined with pain nursing for pain intervention in patients with renal calculi to confirm its application and safety.AIM To study the effect of wrist-ankle acupuncture combined with pain nursing in the treatment of urinary calculi with acute pain.METHODS Eighty-two patients with urinary calculi with acute pain as the first symptom followed at our hospital from November 2019 to June 2021 were enrolled in the study and classified into two groups according to the odd and even numbers of the visit sequences,each with 41 cases.The control group received a routine nursing intervention and intramuscular injection of nonsteroidal anti-inflammatory drugs,whereas the observation group received pain management nursing and wrist-ankle acupuncture.Subsequently,the pain-relieving effect was compared between the two groups.RESULTS The score on the visual analog scale(VAS)at 24,48,and 72 h postintervention was decreased in both groups compared with the baseline data;moreover,the observation group scored significantly lower than the control group on the VAS at each time point after the intervention(P<0.05).The clinical efficacy at 24 h postintervention was not significantly different between the two groups(P>0.05).In turn,the pain recurrence rate at 72 h postintervention was lower in the observation group compared with the control group(P<0.05).Finally,the nursing satisfaction rate in the observation group was significantly higher than that observed in the control group(P<0.05).No serious adverse reactions occurred during the treatment and the safety of treatment was high in both groups.CONCLUSION Wrist-ankle acupuncture combined with pain nursing for treating urolithiasis with acute pain effectively alleviated the degree of pain and reduced the recurrence rate,which was worthy of clinical application.

A pilot clinical study of developing an External Assist Targeting Device for rapid and precise renal calyx access during percutaneous nephrolithotomy

Objective:To design a device to increase the accuracy of the targeting process and reduce the radiation exposure to both the patients and the medical staff.Methods:We analyzed the inherent problem and designed the External Assist Targeting Device(EATD)to assist in the alignment of needle targeting on the desired renal calyx under fluoroscopic guidance.The EATD was designed to allow rapid and precise access to calyces at all angles,with a simple two-step puncture protocol developed for puncturing a target renal calyx.We then tested the device in a pilot human trial with four patients.Results:In experiments with phantom models,the time for successful targeting was reduced by 31%using the device.The mean fluoroscopic time was reduced by 40%.In initial human trial,the puncture time was shortened by 66%and the radiation dose was decreased by 65%compared to free-hand technique.No complication was observed during the trial.Conclusion:The EATD was found to be cost effective,portable,simple to set up,and safe to operate for assisting in the percutaneous nephrolithotomy procedures.Our preliminary tests showed high degree of accuracy in gaining precise access to a targeted renal calyx with much shorter time and lesser radiation dose.The EATD also has the potential to be used to access other organs with precision under fluoroscopic guidance.

A Comparison between Laparoendoscopic Single-Site and Conventional Laparoscopic Renal Stone Removal Surgery: A Study of Application in Two Cases

Aim: To present our initial experience of applying laparoendoscopic single-site surgery (LESS) nephrolithotomy in the treatment of renal calculi. Methods: In August 2010 and April 2012, the LESS nephrolithotomy technique was applied to treat two patients with a renal calculus. One patient had a calculus measuring 5 × 3 cm, and the second patient's measured 3 × 3 cm. Both patients underwent general anesthesia. The operations were performed through a retroperitoneal approach with a single-port instrument inserted through the retroperitoneal incision. The standard laparoscopic retroperitoneal technique was performed, and the calculi were removed by incising the area of the thin renal cortex and the renal pelvis, respectively. The operating time, estimated blood loss, intraoperative complications, other complications, drainage time, and post-operative hospital stay were recorded. Results: Both procedures were completed successfully. No additional trocars were added. No conversion to standard laparoscopic or open surgery was needed. The operating times were 130 min and 120 min, and the estimated blood losses were 40 mL and 30 mL. There were no intraoperative complications. The wound drainage times were 3 d and 2 d, respectively and the post-operative hospital stays were 8 d and 7 d, respectively. There was no secondary bleeding or wound infection. Follow-up times were 2 years and 3 months, respectively. No incidence of hydronephrosis was recorded. Conclusions: LESS nephrolithotomy is safe and feasible for treating kidney calculi. It can be applied in patients with large renal calculi and regionally thin renal parenchyma.

Effects of RIRS and Mini-PCNL on liver and kidney function,endocrine changes and trauma in patients with upper ureteral calculi

Objective: To investigate the effects of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephroscope lithoipsy (Mini-PCNL) on liver and kidney function, endocrine changes and trauma in patients with upper ureteral calculi. Methods: 100 patients with upper ureteral calculi admitted to our hospital from March 2016 to February 2018 were selected. They were randomly divided into observation group (RIRS group) and control group (Mini-PCNL group), with 50 cases in each group. The observation group was given RIRS, while the control group was given Mini-PCNL. At the same time, the expression levels of the liver function [including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma transpeptidase (gamma-GT)], renal function [including urea nitrogen (BUN) and serum creatinine (Scr) levels], endocrine changes [including corticotropin (ACTH), cortisol (Cor), norepinephrine (NE)] and trauma related indexes [Including soluble vascular cell adhesion molecule-1 (sVCAM-1) and erythrocyte sedimentation rate (ESR)] were analyzed and compared between the two groups. Results: There was no significant difference in ALT, AST, γ-GT, BUN and Scr before and after operation between the two groups. The difference was not statistically significant (P>0.05). After operation, the levels of ACTH (27.37±3.29) pg/mL, Cor (150.09±18.47) ng/mL, NE (165.48±26.74) ug/L and sVCAM-1, (596.55±56.24) ng/mL in RIRS group were significantly lower than those in Mini-PCNL group ((38.42±4.33) pg/mL, (222.37±28.70) ng/mL, (287.26±25.29) ug/L and (820.62±72) mL)The differences were statistically significant (P<0.05). While the ESR level in RIRS group (8.29±0.63) mm/h was significantly higher than that in Mini-PCNL group (7.16±0.68) mm/h, and the differences were statistically significant (P<0.05). Conclusions: There is no significant difference in the liver and renal function between RIRS and Mini-PCNL in the treatment of upper ureteral calculi. RIRS can better improve the endocrine status of patients and reduce the damage of the body, which is a more ideal way of operation.

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

酮咯酸氨丁三醇与氢溴酸山莨菪碱在输尿管结石导致的急性肾绞痛患者中的应用效果比较

目的 比较酮咯酸氨丁三醇与氢溴酸山莨菪碱在输尿管结石导致的急性肾绞痛患者中的应用效果。方法 回顾性分析2020年1月至2022年1月于北京市海淀医院急诊外科就诊的166例输尿管结石导致的急性肾绞痛患者的临床资料,采用随机数字法将研究对象分为对照组(肌内注射氢溴酸山莨菪碱,81例)和观察组(肌内注射酮咯酸氨丁三醇,85例)。比较分析两组患者用药前以及用药后30 min、1 h、4 h的疼痛程度,用药后30 min的临床疗效,用药期间的不良反应发生情况。结果 与用药前比较,两组患者用药后30 min、1 h、4 h的视觉模拟评分法(VAS)评分均降低,差异均有统计学意义(P<0.05)。用药前,两组患者的VAS评分比较差异无统计学意义(P>0.05);用药后30 min、1 h、4 h,观察组患者的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。用药后30 min,观察组患者的总有效率高于对照组,差异有统计学意义(P<0.05)。观察组患者用药期间的不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 在输尿管结石导致的急性肾绞痛患者中,与肌内注射氢溴酸山莨菪碱比较,肌内注射酮咯酸氨丁三醇的镇痛效果更好,且不良反应更少。

Structure and Composition of Non-Infectious Phosphate Calculi Formed in Patients with Low and High Urinary Phosphate Concentrations

Objective: The aim of this paper was to assess the relationships among chemical, phase and structural composition and?etiopathogenic factors of non-infectious phosphate calculi formed in patients with low and high urinary phosphate concentrations, and to characterize the mechanism of their formation related on biochemical results. Material and Methods: Twelve samples of phosphate renal calculi were obtained, 4 from patients with low phosphaturia and 6 from patients with high urinary phosphate concentrations. Their chemical composition was determined qualitatively by energy dispersive X-ray analysis and quantitatively by spectrophotometric and thermal analysis;and their phase composition was determined by Fourier transform infrared transmission spectroscopy and X-ray diffraction. The structure of the calculi was assessed by scanning electron microscopy. Results: Non-infectious phosphate renal calculi of patients with low phosphaturia consist of poorly crystalline carbonate hydroxyapatite, whereas those of patients with high urinary phosphate concentrations consist of poorly crystalline hydroxyapatite with some amount of calcium oxalate crystals. Calculi of patients with high urinary phosphate concentrations are formed at urinary supersaturation with respect to hydroxyapatite and calcium oxalate about 4 times higher than in patients with low phosphaturia. Conclusion: In patients with low phosphaturia, the non-infectious phosphate renal calculi are formed in urine near pH 7 and contain only poorly crystalline carbonate hydroxyapatite. In patients with high urinary phosphate concentrations and hypercalciuria, the calculi are formed in urine near pH 6 and consist of both poorly crystalline hydroxyapatite and some amount of calcium oxalate crystals.

可控负压吸引下输尿管软镜钬激光碎石术治疗肾结石合并尿路感染的疗效分析

目的 分析肾结石且伴有尿路感染患者应用可控负压吸引下输尿管软镜钬激光碎石术治疗的临床效果。方法 80例肾结石合并尿路感染患者,将样本经随机法分为实验组和对照组,每组40例。对照组患者接受常压输尿管软镜钬激光碎石术治疗,实验组患者接受可控负压吸引下输尿管软镜钬激光碎石术治疗。比较两组患者术后住院时间、术后血尿时间、手术时间、术后结石清除率及术后感染发生情况。结果 实验组患者的术后住院时间(2.55±1.45)d、术后血尿时间(1.13±0.56)d、手术时间(42.30±4.24)min明显短于对照组的(4.00±2.35)d、(2.20±0.65)d、(63.03±6.33)min(P<0.05)。实验组患者的术后感染发生率为12.5%(5/40),相比于对照组的40.0%(16/40)低(P<0.05),手术更安全、可靠。实验组患者的术后结石清除率97.5%(39/40)显著高于对照组的82.5%(33/40)(P<0.05),术后残石率更低。结论 可控负压吸引下输尿管软镜钬激光碎石术应用于肾结石合并尿路感染治疗中,能够有效缩短住院时间及手术时间,提高术后结石清除率,降低患者术后发热发生率,安全有效。

排石汤对肾结石模型大鼠保护作用及机制研究

[目的]观察排石汤对肾结石模型大鼠肾功能的保护作用,并初步探讨其机制。[方法]采用1%乙二醇和2%氯化铵溶液灌胃建立肾结石大鼠模型,将40只健康雄性SD大鼠随机分为正常组、模型组、枸橼酸钾组和排石汤低、高剂量组,每组8只。给药4周,检测24 h尿量、肾脏系数、血清尿素氮(BUN)、肌酐(Scr)等生化指标,苏木精-伊红(HE)染色检测肾损伤,酶联免疫吸附(ELISA)法检测炎症因子肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-1β(IL-1β),免疫组化法测定转化生长因子-β1(TGF-β1),Western blot法测定丝裂原活化蛋白激酶(p38MAPK)。[结果]与模型组比较,排石汤高、低剂量组24 h尿量明显增加(P<0.01),肾脏系数明显降低(P<0.01),肾损伤程度较轻。与模型组比较,排石汤高、低剂量组BUN和Scr水平明显降低(P<0.01)。与模型组相比,排石汤高、低剂量组TNF-α、IL-6和IL-1β指标显著降低(P<0.01)。与模型组比较,排石汤高、低剂量组TGF-β1/p38 MAPK水平显著低于模型组(P<0.01)。[结论]排石汤能抑制草酸钙结石形成,改善大鼠肾脏功能,降低血中炎症细胞因子水平,抑制TGF-β1/p38 MAPK信号通路,进而发挥肾脏保护作用。

多糖铁复合物胶囊联合重组人促红素注射液治疗肾性贫血的效果

目的 探讨多糖铁复合物胶囊联合重组人促红素注射液治疗肾性贫血的临床效果。方法 选取2020年3月至2023年2月我院收治的100例肾性贫血患者,按照抽签法分为观察组与对照组。对照组采用重组人促红素治疗,观察组采用多糖铁复合物胶囊联合重组人促红素治疗。比较两组的治疗效果、血清指标及不良反应。结果 观察组总有效率为88.00%,高于对照组的64.00%(P <0.05)。治疗后,观察组血红蛋白(Hb)、白蛋白(Alb)、转铁蛋白(SF)、血细胞比容(Hct)水平高于对照组(P <0.05)。观察组血压升高、肝肾功能异常、胃肠功能减弱、发热发生率均低于对照组(P <0.05)。结论 多糖铁复合物胶囊联合重组人促红素注射液治疗肾性贫血的效果较好,可改善患者临床指标水平,降低不良反应发生率。