Appropriate kidney stone size for ureteroscopic lithotripsy:When to switch to a percutaneous approach

Flexible ureteroscopy(f URS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy(PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged f URS is a practical treatmentfor such large kidney stones because f URS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged f URS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with f URS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.

Bilateral hematoma after tubeless percutaneous nephrolithotomy for unilateral horseshoe kidney stones:A case report

BACKGROUND Bilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones,and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous nephrolithotomy(PCNL)for unilateral horseshoe kidney calculi.CASE SUMMARY A 32-year-old man was admitted to our hospital because of repeated intermittent hematuria for 10 years.Plain abdominal computed tomography(CT)scan revealed calculi in the horseshoe kidney;the largest being 2 cm in diameter.Tubeless PCNL was performed to remove the stones.Three days after the operation,the patient was discharged in a stable situation.Three days after discharge,the patient presented to our emergency department because of right low back pain and vomiting.Emergent CT scan revealed subcapsular and perirenal hematocele and exudates in both kidneys.Ultrasound-guided puncture and drainage of perirenal effusion were performed.After the temperature stabilized,the patient received low-pressure injection of urokinase 100000 U for 3 d.His routine blood indexes and the renal function returned to normal in 3 wk.CT re-examination 3 mo after lithotripsy showed that the subcapsular and perirenal hematoma and exudates in both kidneys were significantly absorbed as compared with those before.The patient was followed up for 1 year,during which no flank pain or hematuria recurred.CONCLUSION This is the first case report on the formation of bilateral hematoma following tubeless PCNL for unilateral horseshoe kidney calculi.

Role of simulation in kidney stone disease:A systematic review of literature trends in the 26 years

BACKGROUND Minimally invasive techniques for treatment of urinary stones requires expertise,experience and endoscopic skills.Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.AIM To report the publication trend of‘simulation in urolithiasis’over the last 26 years.METHODS Research of all published papers on“Simulation in Urolithiasis”was performed through PubMed database over the last 26 years,from January 1997 to December 2022.Papers were labelled and divided in three subgroups:(1)Training papers;(2)Clinical simulation application or surgical procedures;and(3)Diagnostic radiology simulation.Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades:period-1(1997-2009)and period-2(2010-2022).RESULTS A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years(training:n=94,surgical procedures:n=66,and radiology:n=8).The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2,an increase of+269%(P=0.0002).Each subgroup shows a growing trend of publications from Period-1 to Period-2:training papers+279%(P=0.001),surgical simulations+264%(P=0.0180)and radiological simulations+200%(P=0.2105).CONCLUSION In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices,with simulators now a part of training programs.With the development of 3D-printed and high-fidelity models,simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.

经皮肾穿刺取石术治疗上尿路结石(20年经验)

目的 :对我院 2 0年来使用经皮肾穿刺取石术 (percutaneousnephrolithotomy ,PCNL)治疗上尿路结石的经验进行总结 ,评价其临床疗效及安全性。方法 :用经皮肾穿刺取石术共治疗上尿路结石 4 0 1 4例 ,其中采用传统PCNL治疗 35 8例 ,经皮肾微造瘘二期输尿管镜取石治疗 5 2 0例 ,微创PCNL治疗 31 36例。结果 :三种方法手术成功率分别为 90 %、95 %和 98% ,结石清除率分别为 82 %、86 %和 91 % ,严重并发症发生率分别为 5 .3%、1 .2 %和0 .5 % ;其中单通道取石 30 2 7例 ,多通道取石 987例 ,手术例次共 5 5 71次。结论 :通过对经皮肾穿刺取石术的不断改进与创新 ,提高了该项技术的手术成功率与结石清除率 ,降低了并发症 。

泌尿系结石B超定位、定量与电针疗效的相关规律研究

随机将 2 17例泌尿系结石肾绞痛患者分为 2组。电针治疗组 187例和药物对照组(Atropine 1mg肌注 ) 30例。观察结果提示 :①对肾绞痛的缓解作用 ,电针组优于药物对照组 ;②通过B超动态显示结石的定量、定位与电针疗效的相关规律 ,从而选择出电针治疗泌尿系结石的最佳适应症是中。

全息电针排石技术治疗尿石症疗效观察

目的 :探索尿石症无创伤性体外排石新技术。方法 :86例尿石症随机分成两组 ,观察全息电针排石技术促排石作用 (治疗组用全息电针排石技术加中药 ,对照组用中药 )和镇痛作用 (治疗组用全息电针排石技术 ,对照组用度冷丁 )。结果 :治疗组总排石率 62 5 0 % ,比对照组 39 13%显著增高 (P <0 0 5 )。治疗组肾结石排石率 5 4 5 5 % ,比对照组 12 5 0 %显著增高 (P <0 0 1)。治疗组产生镇痛时间和镇痛持续时间分别为 5 5 2± 3 98分钟 ,3 92± 1 5 8小时 ;对照组分别为 5 17± 3 81分钟 ,4 13± 2 14小时 ,两组比较差异无显著性意义 (P均 >0 0 5 )。结论 :全息电针排石技术具有促排石作用和解痉镇痛作用。

针刺治疗肾绞痛疗效观察

用针刺疗法治疗肾绞痛患者25例,并与27例西药治疗组作对照。结果无论在止痛时间方面,还是在无副作用方面均明显优于对照组。从而证实其具有'快、便、廉'之特点,适合于基层广泛推广使用。

B超引导下电针治疗输尿管上段结石46例临床观察

目的 :观察B超引导下电针对碎石术后输尿管上段结石的疗效。方法 :将 91例患者随机分为体外冲击波碎石术后应用B超引导下电针治疗组 (46例 )和单纯采用体外冲击波碎石术对照组 (45例 ) ,观察治疗 2周后的临床疗效。结果 :治疗组与对照组比较总有效率和治愈率均有显著性差异 (P <0 0 1和P <0 0 5 )。结论 :B超引导下电针治疗碎石术后的输尿管上段结石 ,镇痛效果好 ,疗效确切。

中医平衡阴阳法治疗尿路结石的临床研究

[目的]观察中医平衡阴阳法对尿路结石的疗效。[方法]在补肾利水、溶石排石的基础上,配合酸甘化阴或甘温成扶阳中药治疗尿路结石患者100例,并与西药对照组100例做疗效比较。[结果]治疗组治愈85例,好转10例,无效5例,治愈率85％,总有效率95％;对照组治愈24例,好转70例,无效6例,治愈率24％,总有效率为94％。两组比较总有效率差异无显著性(P>0.05),但治愈率差异有显著性(P<0.001)。[结论]中医平衡阴阳法治疗尿路结石,可使结石加速溶解,具有一定的疗效。

十四年来针灸治疗泌尿系结石近况

本文据１９８０～１９９３年有关文献报道，从针刺镇痛、针灸排石、针刺机理三方面对泌尿系结石的针灸治疗、研究概况作一综述，并在此基础上提出：①无论采取哪种针刺手法均须得气，气至方有效；②要提高针灸的排石率，除正确的辩证选穴、施本外，还要抓住疼痛这一排石的良机。

加减大柴胡汤治疗胆道残余结石98例

对 98例胆道术后残余结石患者采用加减大柴胡汤持久间歇内服治疗 ,在间歇期服用加味四君子汤 ,排石 6 5例 ,随访 5 a,症状未再发 5 2例 ,总有效率6 6 .3%。此疗法优点在于能使患者在较长的时间内多次排石 ,从而达到根治目的。

EBPH－Pl000型压电陶瓷源碎石机临床前研究

目的：了解ＥＢＰＨ－Ｐｌ０００型压电碎石机的有效性和安全性。方法：对模拟犬肾结石进行实验治疗，观察破碎效果，并对犬肾进行直接冲击，观察冲击前后肾脏病理、超微结构及血清生化指标的改变。结果：模拟犬肾结石可以有效地破碎，压电冲击波可致肾脏出血、线粒体肿胀和血清ＡＳＴ升高（Ｐ＜０．０１），但均为一过性轻微损伤，对肾功能无明显影响。结论：ＥＢＰＨ－Ｐ１０００型碎石机具有碎石颗粒细小，对肾脏损伤轻微等优点，值得在临床推广使用。

Indications and contraindications for shock wave lithotripsy and how to improve outcomes

For over 35 years shock wave lithotripsy has proven to be an effective,safe and truly minimally invasive option for the treatment of nephrolithiasis.Various technical factors as well as patient selection can impact the success of the procedure.We used published work focusing on outcomes of shock wave lithotripsy,risk of complications,and strategies for improving stone fragmentation to create this review.Multiple patient and technical factors have been found to impact success of treatment.Skin to stone distance,stone density and composition,size and location of the stone within the urinary system all influence stone free rates.A slower rate with a gradual increasing voltage,precise targeting,proper coupling will improve stone fragmentation and decrease risk of complications.The selection of appropriate patients through a shared decision making process and attention to the technical factors that improve stone free rates is key to providing an effective treatment and patient satisfaction.

承山穴穴位注射治疗泌尿系结石疼痛疗效观察

方法 :将 12 0例泌尿系结石疼痛患者随机分为 3组 ,A组承山穴位注射黄体酮 ;B组单纯针刺承山穴 ;C组黄体酮臀部肌肉注射 ,观察其止痛效果并进行比较。结果 :3组的总有效率分别为 :A组 93 0 % ,B组 71 8% ,C组 6 0 5 %。结论 :黄体酮承山穴位注射对泌尿系结石引起的疼痛效果明显优于其它两组 (P <0 0 1)。

Role of insulin resistance in uric acid nephrolithiasis

Metabolic syndrome has been implicated in the pathogenesis of uric acid stones.Although not completely understood,its role is supported by many studies demonstrating increased prevalence of uric acid stones in patients with metabolic syndrome and in particular insulin resistance,a major component of metabolic syndrome.This review presents epidemiologic studies demonstrating the association between metabolic syndrome and nephrolithiasis in general as well as the relationship between insulin resistance and uric acid stone formation,in particular.We also review studies that explore the pathophysiologic relationship between insulin resistance and uric acid nephrolithiasis.

电针天枢穴治疗肾绞痛疗效观察

目的 :观察天枢穴治疗肾绞痛的即时止痛作用。方法 :将 97例肾绞痛患者采用半随机方法分成电针组 (5 5例 )和药物组 (42例 )。电针组采用电针天枢穴治疗 ,药物组采用度冷丁 5 0mg肌肉注射治疗。结果 :电针组显效率为 5 2 7%,总有效率为 96 4%;药物组显效率为 2 8 6 %,总有效率为 73 8%。经统计学处理 ,两组显效率和总有效率的差异具有非常显著性意义 (P <0 0 1 )。结论 :对肾绞痛的缓解作用 ,电针组优于药物组。

Education and training evolution in urolithiasis:A perspective from European School of Urology

Objective:With the worldwide increase in urolithiasis prevalence,the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis.Methods:A PubMed search using the key words“simulation”,“training”,“ureteroscopy”,“RIRS”,“URS”,“percutaneous nephrolithotomy”,“PCNL”,“virtual reality”,“augmented reality”,“artificial intelligence”,“healthcare”,“curriculum”,and“assessment”was used to examine how education and training in urolithiasis have adapted over recent years.Focus was placed on the role of high-and low-fidelity simulation models,virtual reality and artificial intelligence,and standardised assessment and curriculum.Results:This review supports the necessity to incorporate technology,simulation,and other skill enhancement training modalities into surgical training.However,these cannot solely replace mentored training with an experienced professional supervisor.Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training,it is just as important for stratification of robust curricula with validated assessment.We also propose a pathway for future training.Conclusion:Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition,refinement,and improving operative outcomes.Success is achieved by maintaining a delicate balance between machine and in person mentor-based training.A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.

直肠气囊辅助盆段以下输尿管结石ESWL B超定位

本文报告拟行ESWL的盆段以下输尿管结石病人157例,直接定位成功40例(25.48％),采用直肠内置入气囊辅助再定位117例,成功111例(70.70％),失败6例(3.82％)。碎石成功并排净结石149例(98.68％)。认为直肠气囊辅助盆段以下输尿管结石ESWL B型超声定位能提高成功率和准确性,简单方便实用。

Point Injection for Treating Nephritic Colic

Since 1994, the authors have treated 101 cases of nephritic colic by point injection therapy and achieved good curative results. Of them, 70 cases were diagnosed as having renal or ureteral calculi confirmed by abdominal X-ray and B-ultrasonic examination; and the others had the following symptoms: 1) sudden onset; 2) angina in unilateral lumbar and abdominal regions; 3) percussion-induced pain in the ipsilateral kidney region; and 4) erythrocytes or visible blood in urine found by laboratory test.

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.