Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys

BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.METHODS This was a retrospective study of 12 patients with HK and a limited number(n≤3)of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy(June 2012 to May 2019).The perioperative data of both groups were compared including operation time,estimated blood loss,postoperative fasting time,perioperative complications and stone-free rate(SFR).RESULTS No significant difference was observed for age,gender,preoperative symptoms,body mass index,preoperative infection,hydronephrosis degree,largest stone diameter,stone number and isthmus thickness.The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29±0.49 and 2.40±0.89 d,respectively(P=0.019).There was no significant difference in operation time(194.29±102.48 min vs 151.40±39.54 min,P=0.399),estimated blood loss(48.57±31.85 m L vs 72.00±41.47 m L,P=0.292)and length of hospital stay(12.14±2.61 d vs 12.40±3.21 d,P=0.881)between the retroperitoneal and transperitoneal groups.All patients in both groups had a complete SFR and postoperative renal function was within the normal range.The change in estimated glomerular filtration rate(e GFR)from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was-3.86±0.69 and-2.20±2.17 m L/(min·1.73 m2),respectively(P=0.176).From the preoperative stage to the 3-mo follow-up,the absolute change in e GFR values for patients in the retroperitoneal group and the transperitoneal group was-3.29±1.11 and-2.40±2.07 m L/(min·1.73 m2),respectively(P=0.581).CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.

Sheathless and fluoroscopy-free retrograde intrarenal surgery:An attractive way of renal stone management in high-volume stone centers

Objective:To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy(FURSL)for treating renal stones.Methods:Between May 2015 and May 2017,135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated.Our technique involved a semirigid ureteroscopic assessment of the ureter,and the guidewire was left in situ to railroad the flexible ureteroscope.A holmium laser was used to fragment and dust the stones;fragments were neither grasped nor collected.Results:The study population consisted of 135 patients including 85 males(62.96%)and 50 females(37.04%)with a mean age of 40.65 years(range:3-70 years)were evaluated.The mean stone size was 17.23 mm(range:8-41 mm).Complete stone-free status was achieved in 122(90.37%)patients and clinically insignificant residual fragments(CIRF)in two(1.48%),while residual stones were still present in 11(8.15%)patients.Postoperative complications occurred in 23(17.4%)cases and were mostly minor,including fever in 17(12.6%),pyelonephritis in four(3.0%),subcapsular hematoma in one(0.7%)and steinstrasse in one(0.7%).These complications were Clavien Ⅰ-Ⅱ,GⅠ in 17(12.6%)patients,GⅡ in five(3.7%),and Clavien Ⅲb in one(0.7%).No major complications were observed.Stone size2 cm,operative time ≥30 min,and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis(p<0.05).Conclusion:Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management,especially for stones under 2 cm in diameter.This process is a feasible option for avoiding sheath complications,which can protect surgeons from the negative effects of radiation.

Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

Objectives:The present study compared the safety and efficacy of combined laparoscopic ureterolithotomy(LU)and flexible ureteroscopy with percutaneous nephrolithotomy(PCNL)for removing large impacted upper ureteral stones with concurrent renal stones.Methods:This study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones(group A)or PCNL(group B)for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016.Patient demographics,stone characteristics,and procedure-related parameters including stone-free rate,operation time,hospital stay after surgery,mean decrease in hemoglobin levels,visual analog scale(VAS)score,auxiliary procedure rate,and complication rate were compared between groups A and B.Results:Results of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones.The stone-free rate after a single procedure was 95.7%in group A and 89.7%in group B(p?0.62).The operation time was longer in group A than in group B(112.2±23.3 min versus 96.2±16.4 min,p?0.006).However,no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery(5 days versus 6 days,p?0.06).The decrease in hemoglobin levels was significantly higher in group B than in group A(0.64±0.36 g/dL versus1.44±0.65 g/dL,p<0.0001).The mean VAS scores obtained at 24 hours(2.91±1.08 versus 5.10±1.01,p<0.0001)and 48 hours after the surgery(1.09±0.73 versus 2.28±0.96,p<0.0001)were significantly higher for group B than for group A.Moreover,the auxiliary procedure rate was higher in group B than in group A(6.9%versus 0%).Conclusion:These results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards.Despite the longer operation time,the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications.However,the choice of treatment depends on the preferences of surgeons and patients.

The effect of renal stones on serum adenosine aminohydrolase and AMP-aminohydrolase in Malaysia

Objective: To verify possible associations between adenosine aminohydrolase(ADA) and AMP-aminohydrolase(AMPDA) to E3 SUMO-protein ligase NSE2(NSMCE2) in patients with renal stones. And to isolate, purify and characterize ADA in patients with renal stones and healthy group.Methods: A total of 60 renal stones patients and 50 control were enrolled in a case-control study. The blood urea, creatinine, uric acid, protein, albumin, ADA and AMPDA were measured by colorimetric tests. The serum NSMCE2 was measured by ELISA.Results: Serum ADA, AMPDA and specii c activity of enzymes showed signii cant decrease(P < 0.05) in patients with renal stones compared to control group, mean levels of sera NSMCE2 and uric acid had a signii cant increase(P < 0.01 and P < 0.05, respectively) in patients compared to control group.Conclusions: The present study suggests that ADA, AMP deaminase and NSMCE2 can be used as a indicator to monitor the DNA damage and inl ammation disorders in the patients with kidney stones.

Vitamin D₃Variation between Children and Adults with Reference to Renal Stones, Environment and Urinary Tract Infections

Purpose: A better understanding of urinary tract infection (UTI) and the role of host, bacterial and environmental factors have improved the ability to identify the patients at risk and prevent or minimize sequelae. Kidney stones may be a complicated subject and its etiology is related to diet, increase urinary solutes and colloids in hot weather. Hypercalcaemia produced by taking large doses of vitamin D, creates high blood pressure and calcium deposits that can produce renal and bludder stones in all age groups including children. The objective of the present study was to estimate the serum level of vitamin D among patients particularly children taking treatable vitamin D. Correlation between vitamin D renal stones and UTI was also assessed. Methods: The number of patients studied was 150 collected during 2010 and 2011 in University teaching hospital. Forty two of them were children. The patients under study should have renal stone confirmed by ultrasound examination. Urine, blood and stone samples were taken for relevant laboratory investigations including identification of bacteriuria and its causative agents. Serum ions and vitamin D were also estimated. Type of renal stone collected was chemically identified. Results: One hundred and fifty patients with urolithiasis were included in the present study whose ages ranged from 8 months to 69 years and the ratio of males to females was 1.7:1. The frequency of patients revealed UTI was 52% and 78% of the infected patients were suffered from Gram-negative bacteria particularly Escherichia coli. Renal stones of mixed chemical composition were almost 72% and 78.2% of the stones were infection type. The mean of serum calcium was 2.157 mmol/L. The serum means of vitamin D among children and adults were 50.9 and 31.4 nmol/L respectively and the peak of this vitamin was recorded during summer. Conclusion: The frequency of UTI among urolithiasis patients was greater than that of non-urolithiasis. Enterobacteriaceae was the dominant family causing UTI particularly among females. Urolithiasis was more prevalent in males (62%). Recurrence of urolithiasis was high (39%) which indicated insufficient treatment of the underlying causes. Serum ions concentrations among children and adults were variables. Vitamin D values in children were higher than those estimated among adults and the peak of its overall concentration mean was found during summer (39.7 nmol/L). There was a strong relation between vitamin D level and the incidence of urolithiasis particularly among children with dietary problems.

Occurrence of Nanobacteria-Like Particles in Renal Stones of a Southern Brazilian Population

Purpose: Identifying the source of stone formation in recurrent stone formers has always been a big problem. Material and Methods: In this study kidney stones from 52 patients were submitted to direct examination by scanning electronic microscopy (SEM) after manual fracture and 27 calculi were cultured in Eagle’s Minimum Essential Medium (E-MEM) and Brain-Heart Infusion (BHI) for eight weeks at 37°C in 5% CO2 atmosphere. Twenty-seven powdered and demineralized stones were suspended in sterile PBS, filtered through 0.22 m-pore-size sterile filters Millex (Millipore, Massachusetts, USA) and submitted to DNA extraction (Quiagen-Brazil). Platinum PCR SuperMIX (GIBCO-BRL), primers (Invitrogen), and Ultra Pure Water (Advanced Biotechnologies, Columbia, MD) were used for PCR (Polymerase Chain Reaction), which was generally conducted for 30 or 35 cycles with annealing of primers for 40 sec at 55°C and extension for 1 min at 72°C. Results: In 36 out 52 (69%) kidney stones it was detected the presence of biofilm coating the mineral surface of the stone when examined by SEM, consisting of coccoid particles, isolated or clustered, with diameter of 500 nm or less. Eleven out 27 (41%) kidney stone cultures produced white-colored sediment on the bottom of the tubes after eight-week incubation, revealing tiny structures similar to those observed directly by SEM. These structures were similar in size and morphology to spherical apatite particles previously observed in human kidney stones and named as nanobacteria (NB). No PCR products were observed in the samples. Conclusion: We found a strong correlation between renal stones and calcifying nanoparticles (CNP) in this study and these results open a new insight on this area to explore the etiology of stone formation. Whether NB/CNP are truly microorganisms or self-propagating mineral compounds is still controversial and its contribution, if any, in apatite nucleation and crystal growth remains uncertain.

Metabolic evaluation of first-time uncomplicated renal stone formers:A prospective study

Background:Nephrolithiasis is a global health problem.The recurrence rate after the first stone clearance is approximately 50%at 5 years.Metabolic abnormalities are an important factor responsible for stone recurrence.Our prevalidated study aimed to evaluate metabolic abnormalities associated with first-time uncomplicated renal stone formers(FTURSF).Materials and methods:In this prospective,exploratory,time-bound,descriptive study,30 first-time renal stone formers were evaluated for metabolic abnormalities.High-risk stone formers were excluded from the study.Data were collected in a predefined proforma,transferred to an Excel sheet,and analyzed using the Statistical Package for Social Sciences 20 and Epi Info 7.Fisher exact test,Mann-Whitney U test,paired t test,and Pearson correlation coefficient were used for statistical analyses.Results:The mean age of the participants was 35.57±11.07 years,with a male-to-female ratio of 1.72.The most common abnormality was a 24-hour urine volume of<2.5 L in 73.33%of the participants.One or more metabolic abnormalities were detected in 76.67%of the participants.Other common metabolic abnormalities detected were hypocitraturia(60%),hypercalciuria(16.67%),hyperoxaluria(13.33%),and hyperuricosuria(3.33%).Parathyroid adenoma was detected in one participant(3.33%).Conclusions:Our study documented significant metabolic abnormalities in FTURSF.Therefore,a simplified metabolic evaluation protocol should be adopted while evaluating FTURSF.Detection of an underlying metabolic abnormality would enable the early institution of preventive measures to reduce stone recurrence and related complications.

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.

Extracorporeal Shock Wave Lithotripsy Treatment for Renal and Ureteral Stones in Duhok City

The present study reports the results of extracorporeal shock-wave lithotripsy treatment for renal and ureteral stones in Duhok city. The data were collected from the center of breakdown kidney stones in Duhok hospital. There were a total of 40 patients (25 males and 15 females) aged from 20 to 60 years old. The patients harboring (23 renal and 17 ureteral) stones of size ranged from 7.5 to 20 mm. Almost stones are of average size 9 mm and composed of uric acid, calcium and cystine stones. The study has been carried out by taking into consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and sessions). The results show that the stones size increases according to increasing ages of patients (male and female) for uric acid ureter stone and calcium (renal, ureter) stones. Also (renal, ureter) stone size for patients aged from 20 to 30 years old increases from the minimum value for phosphate to maximum value for cystine stones, while for patients aged from 40 to 60 years old, the minimum size is obtained for calcium oxalate and the maximum size for calcium only. On the other hand, for uric acid stones of average size 9 mm, number of shock wave and sessions as well as the power required to breakdown the stones decrease nearly exponentially according to enhancing patients’ ages. At the same time, it's found that for adult patients (20 - 30 years old), number of sessions and the power of shock wave decrease also according to increasing size of calcium and cystine stones. Contrary to that, for the same ages and renal, uretral cysteine stones number of shock wave needed to breakdown large stones will be increased.

Effectiveness of Using Renalof®in the Elimination of Kidney Stones under 10 mm Located in the Renal-Ureteral Tract

Background: In view of the high recurrence of kidney stones in patients, the search for less aggressive, preventive treatments has become increasingly essential. Renalof® offers a phytotherapy alternative. Due to its diuretic and kidney stone demineralisation properties, it has been widely used in this patient population, disintegrating and eliminating calcium oxalate and struvite kidney stones painlessly in the genitourinary system. Methods: A Phase II, randomised, prospective, observational, single-blind study with two treatment arms was conducted in order to determine the efficacy of this alternative therapy: a total of 155 patients were enrolled, 120 were assigned to a Renalof® treatment group and 35 to the placebo group. All were over 18 years of age, of both genders, diagnosed with kidney stones of under 10 mm in diameter, present along the entire renal-ureteral-vesicular tract, diagnosed by ultrasound and renal CAT scan. Divided into two study arms, 120 were administered a dosage of a single 325 mg capsule of the Renalof® product half an hour before the two main meals for 3 months. The presence of kidney stones in any part of the renal-ureteral tract was assessed at monthly consultations using one of the above-mentioned diagnostic tools. Results: Study results show a high rate of effectiveness with Renalof®, finding up to a 65% expulsion rate (78 patients) in the first 8 weeks of treatment, compared to 11.4% (4 patients) in the placebo control group, P < 0.001. It is likely a longer follow-up period would be necessary in patients with kidney stones of 10 mm in diameter or larger than the period applied in the study. Discussion: We strongly recommend the inclusion of this product in kidney stone disease management protocols, especially for patients with kidney stones under 10 mm in diameter, where high response and effectiveness have been observed. Thus, it should be evaluated to reduce surgical treatment costs, as well as those for possible colic episodes and other associated complications.

Bilateral stones as a cause of acute renal failure in the emergency department

BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.

Simple Renal Cyst with Clustering of Small Stones in an Elderly Patient withType II Diabetes Mellitus

Intracystic renal stones are rare.The authors wishto report here an aged case of type 2 diabetes mellituscomplicated with sohtary renal cyst with intracysticstones.

单通道经皮肾镜联合输尿管软镜治疗合并肾盏颈口狭窄的复杂肾结石疗效观察

目的 探讨单通道经皮肾镜取石术(PCNL)联合输尿管软镜碎石术(RIRS)治疗合并肾盏颈口狭窄的复杂性肾结石的安全性及疗效。方法 回顾性分析2019年7月至2022年2月金华市中心医院收治的26例合并肾盏颈口狭窄的复杂性肾结石患者。所有患者均存在不同程度肾盏颈口狭窄伴肾盏积水,其中狭窄位于上盏21例,中盏3例,下盏2例;3例双侧肾结石,14例肾及输尿管多发结石,18例鹿角形结石。结石大小(40.6±13.5)mm,CT值(1 124.7±364.0)HU,结石负荷评分系统评分(8.7±0.8)分。所有患者均采用顺行PCNL联合RIRS。结果 26例患者均顺利完成手术并扩张狭窄通道留置双J管,平均手术时间(110.8±36.2)min。术中、术后均无严重出血和感染并发症。泌尿手术后并发症评分系统Ⅰ、Ⅱ级并发症发生率分别为7.7%(2例)、15.4%(4例),无Ⅲ级以上并发症。术后1个月复查腹部CT,一期结石取净率80.8%(21/26),二期结石取净率92.3%(24/26)。术后2~14 d拔除肾造瘘管,术后1~3个月拔除双J管。术后随访3~12个月,未见狭窄复发。结论 PCNL联合RIRS治疗合并肾盏颈口狭窄复杂性肾结石可有效扩张狭窄通道,结石取净率高且并发症少,是一种安全有效的治疗方案。

肾结石患者报告结局测评量表的汉化及信效度检验

目的 汉化剑桥肾结石患者报告结局(PRO)测评量表(CReSP),并对其进行信效度检验,以期为临床评估肾结石PRO提供特异性量表。方法 对原量表进行翻译-回译-跨文化调试-预实验,形成中文版量表。于2021年8月-2022年4月选取我院420例肾结石患者作为研究对象进行调查研究,验证量表的信效度。结果 中文版CReSP共包括6个维度、14个条目。量表各条目的内容效度指数为0.80~1.00,量表内容效度指数为0.79;提取公因子共6个,方差累计贡献率为78.602%;Promax斜交旋转后各条目因子载荷量为0.650~0.989,验证性因子分析结果显示模型适配度良好。量表及各个维度Cronbach′s α系数为0.859~0.959;其重测信度为0.804~0.941。结论 中文版CReSP具有良好的信效度,可作为肾结石PRO的特异性评价工具。

逆行输尿管软镜联合可弯曲负压吸引鞘治疗>2 cm肾结石的疗效观察

目的 探讨逆行输尿管软镜联合可弯曲负压吸引鞘治疗>2 cm肾结石的安全性、可行性及疗效。方法 回顾性分析2021年11月至2023年5月68例采用输尿管软镜联合可弯曲负压吸引鞘治疗>2 cm肾结石患者的临床资料。评估结石清除率及并发症等情况。结果 结石长径2.1~3.7(2.56±0.55)cm,CT值638~1485(929.2±286.9)Hu。一次进镜成功率100%,手术时间50~170(95.4±27.9)min。术后4周总结石清除率88.24%,其中结石长径2~3 cm组清除率93.88%,>3 cm组清除率73.68%。术后总并发症发生率2.94%,其中结石长径2~3 cm组并发症发生率2.04%,>3 cm组并发症发生率5.26%。2例均为术后高热,经抗感染治疗后好转。所有患者无大出血、脏器损伤等并发症发生。结论 逆行输尿管软镜联合可弯曲负压吸引鞘治疗>2 cm肾结石是安全可行的,且并发症少,临床疗效确切,可在临床推广应用。

肾上盏与肾中盏穿刺路径在经皮肾镜碎石术中的临床疗效对比

目的:探讨超声引导下肾上盏和肾中盏穿刺路径在经皮肾镜取石术(PCNL)中的临床效果。方法:回顾性分析2022年5月—2023年10月于宜昌市中心人民医院行PCNL的220例上尿路结石患者的临床资料,根据穿刺路径分为两组,经肾上盏穿刺为观察组(n=108),经肾中盏穿刺为对照组(n=112)。对比两组患者的治疗效果及手术并发症。结果:观察组患者手术时间(46.42±9.73 min vs 69.13±15.78 min)、住院时间(5.13±1.20天vs 6.29±1.53天)均明显低于对照组(均P<0.05),观察组患者一期结石清除率(82.41%vs 71.43%)显著高于对照组(P<0.05),两组患者术后血红蛋白下降量及肌酐值无明显差异(均P>0.05)。两组患者术后并发症总发生率无明显差异(P>0.05)。结论:超声引导下经肾上盏穿刺路径行PCNL可缩短手术时间及住院时间,提高一期结石清除率,临床效果确切,安全有效。

采用自制一体式输尿管肾导管与常规方式行PCNL治疗肾结石的疗效、安全性及患者满意度对比

目的 比较常规经皮肾镜碎石取石术(PCNL)与应用一体式输尿管肾导管的PCNL在治疗肾结石方面的安全性、疗效及患者满意度,为肾结石患者的临床治疗提供参考。方法 回顾性分析2022年4月—2023年5月新疆和田地区人民医院收治的154例肾结石(结石最大径为1.5~3.5 cm)患者资料。根据术中碎石结束后双J管和肾造瘘管的置入方式分为一体式组(应用一体式输尿管肾导管,n=77)和标准组(常规PCNL术式,n=77),比较两组患者的一般特征及术前、术后及随访资料。结果 一体式组和标准组术后住院时间[(5.78±2.50)d vs.(5.29±2.18)d,P=0.193]、术后疼痛评分[(2.22±0.42)分vs.(2.30±0.46)分,P=0.273]、术前及术后血红蛋白的变化值[(-4.13±10.11)g/L vs.(-2.96±9.39)g/L,P=0.459]、住院费用[(17 088.14±2 876.94)元vs.(16 389.74±2 427.37)元,P=0.105]、结石清除率[65(84.4%)vs.66(85.7%),P=0.821]等数据差异均无统计学意义(P>0.05)。术后随访发现一体式组较标准组的不适症状发生率较低[36.4%(28/77)vs.90.9%(70/77),P=0.001],满意度更高(一体式组77例全部满意,标准组中64例满意、13例基本满意)。所有患者均未出现术后脓毒血症及感染性休克,未发生转入重症监护室等情况。结论 一体式输尿管肾导管PCNL和常规PCNL安全性和疗效相当,但一体式组满意度更高,值得临床在把握适应证的情况下选择使用。

基于随机森林算法建立肾结石腔内手术后并发尿脓毒血症预警模型的价值

目的探讨基于随机森林算法建立肾结石腔内手术后并发尿脓毒血症的预警模型的价值。方法以行腔内手术治疗的362例肾结石患者为研究对象,根据患者术后是否发生尿脓毒血症将其分为尿脓毒血症组和非尿脓毒血症组,收集患者的临床资料,采用多因素logistic回归筛选影响患者术后并发尿脓毒血症的危险因素,运用R软件建立预测肾结石腔内手术患者术后并发尿脓毒血症的随机森林模型,并验证模型效能。结果34例患者肾结石腔内手术后发生尿脓毒血症、发生率为9.39%;尿脓毒血症组和非尿脓毒血症组患者的年龄、性别、糖尿病、结石直径、结石数量、感染性结石、手术时间等资料比较,P<0.05;多因素logistic回归筛选结果显示,年龄、性别、糖尿病、结石直径、结石数量、感染性结石、手术时间均为肾结石腔内手术患者术后发生尿脓毒血症的独立危险因素(P<0.05),随机森林模型对肾结石腔内手术后并发尿脓毒血症重要性预测的排序为手术时间、糖尿病、感染性结石、性别、结石直径、结石数量以及年龄,两种模型均具有较好的预测效能。结论随机森林算法建立的风险预测模型对肾结石腔内手术后并发尿脓毒血症具有较好的预测效能。

Retrograde intrarenal surgery in pediatric patients

Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.

一次性超细输尿管软镜联合头端可弯曲负压吸引鞘在上尿路结石一期治疗中的应用效果

目的 探讨一次性超细输尿管软镜联合头端可弯曲负压吸引鞘在上尿路结石一期治疗中的应用效果。方法 选取236例上尿路结石患者为研究对象。通过回顾分析,将患者分为研究组(n=118)和对照组(n=118)。研究组采用一次性超细输尿管软镜联合头端可弯曲负压吸引鞘进行治疗,对照组采用一次性超细输尿管软镜联合常规鞘进行治疗。比较2组术后疼痛程度[视觉模拟评分法(VAS)]、炎症指标、应激指标、肾功能指标以及并发症发生率、结石清除率。结果 术后1、2、3 d,对照组患者VAS评分高于研究组,差异有统计学意义(P<0.05)。术后1 d,研究组C反应蛋白、白细胞介素-6和降钙素原以及去甲肾上腺素、皮质醇水平低于对照组,差异有统计学意义(P<0.05)。术后1 d,研究组尿素氮、血肌酐、尿酸、胱抑素C水平高于对照组,差异有统计学意义(P<0.05)。研究组总并发症发生率为14.4%,低于对照组的27.1%,差异有统计学意义(P<0.05)。研究组术后结石清除率为98.3%,高于对照组的88.1%,差异有统计学意义(P<0.05)。结论 一次性超细输尿管软镜联合头端可弯曲负压吸引鞘在上尿路结石一期治疗中的应用效果较好,其可提高结石清除率,降低并发症发生率,减轻术后疼痛及炎症反应,以及促进患者肾功能恢复。