Cost-Effectiveness Analysis of Renalof® versus Extracorporeal Shockwave Lithotripsy (ESWL) for the Treatment of Kidney Stones ≤ 1 cm in Nicaragua

Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.

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.

Breakdown of Kidney and Ureteral Stones Using Extracorporeal Shock Wave Lithotripsy in Zakho City

In the present study, investigation of extracorporeal shock wave lithotripsy in Zakho City for breakdown kidney and ureteral stones has been carried out. The data were collected from the center of breakdown kidney stones in Zakho hospital. A total of 34 patients (25 male and 9 female) of ages ranged from 20 - 60 years were treated with ESWL. The patient harboring 24 renal stones and 10 ureteral stones of size ranged from 7 to 23 mm of almost patients are 8 mm and composed of calcium oxalate. The study has been conducted taking in to 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 session). The results show that the number of shock wave decreases nearly exponentially with the ages of patients for calcium oxalate stone of size 8 mm under constant power 4 watt while it tends to increase according to increasing stones size for the patients of ages 20 - 30 years. The size of calcium oxalate stones decreases nearly exponentially with the patients’ ages for workers in Zakho city. Also for same size 8 mm of (calcium, phosphate, and oxalate) stones and different regions of zakho city, the number of shock waves decreases according to increasing ages of patients. Contrary to that for certain size of stones 8 mm, the number of shock wave starts to increase from uric acid to maximum value for calcium oxalate stone for the adult patients of age’s 22 up to 30 years. However for elders ages 30 - 60 years and different regions, the size of renal and ureteric stones increases from the minimum value for calcium, phosphate, oxalate to maximum value for calcium oxalate stone only. Uric acid stone requires minimum power to break, while the calcium oxalate needs maximum power to fragment due to its hardness composition. Later number of session of shock wave required for crushing each stones size increases according to increasing its size while its variation due to enhancing patients ages for calcium oxalate of size 8 mm results in nearly a decreasing exponential behavior.

Kidney stones over 2 cm in diameter-between guidelines and individual approach

The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery(pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm:A private center experience

Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is due to the need to refine the decision making in the context of technological advancements and current pandemics.This study aimed to determine the predictors of stone-free rate(SFR)after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter.Materials and methods:A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021.Univariate and multivariate analyses were performed for stoneand patient-related factors,using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables.Results:A total of 138 patients were eligible for this study,including 92 men and 46 women.The mean age was 38.6±12.4years,and the mean body mass index(BMI)was 25.9±3.4kg/m^(2).Four weeks after SWL,120 patients(87%)were free of stones,and 18(13%)needed further treatment.Univariate analyses showed that SFR was negatively correlated with increased BMI(p=0.0001),maximum stone length(p=0.0001),transverse diameter of the stone(p=0.0001),number of shocks per session(p=0.052),and Hounsfield unit(HU)(p=0.0001).Multivariate analysis revealed that HU(p=0.009),maximum stone length(p=0.01),BMI(p=0.000),and presence of double-J stent(p=0.034)were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter.The estimated average cost per case was USD 450.5.Conclusions:Increased HU,maximum stone length,BMI,and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter.The cost of SWL remains an advantage in the private sector.

Effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on the levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi

Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.

Comparative evaluation of urolithiasis management options in patients with horseshoe kidney:A systematic review and meta-analysis

Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options for horseshoe kidney stones.The aim of this systematic review is to compare the benefits and risks of these management options.Methods:MEDLINE,EMBASE,and Cochrane Library databases were searched from inception to February 2022.A total of 516 nonduplicate studies were screened against the inclusion and exclusion criteria.Studies comparing at least 2 interventions with>10 patients per intervention were included.Results:Nine retrospective observational studies published from 2007 to 2021 with a total of 565 patients were included.Reported mean±SD or mean(range)stone sizes ranged between 17.90±2.43 mm and 27.9±8.6 mm for PCNL,8.4(2-25)mm and 22.3±9.1 mm for URS,and 11.9±2.0 mm and 16.8±4.4 mm for ESWL.There was no difference in single-session and overall stone-free rate(SFR)between PCNL and URS,with a risk ratio of 1.04(95%confidence interval,0.95-1.13;I2=20.63%).Ureteroscopy had better stone clearance than ESWL,with an overall SFR risk ratio of1.38(95%confidence interval,1.04-1.82;I2=0%).There was no statistically significant difference in overall SFR between PCNL and ESWL.Most patients who underwent URS and ESWL experienced Clavien-Dindo(CD)gradeⅠ-Ⅱcomplications.Percutaneous nephrolithotomy was associated with the highest complication rates,including 5 CD gradeⅢand 3 CD gradeⅣcomplications and a mean postoperative hemoglobin drop of 0.47 to 1.83 g/dL.There were no CD grade V complications across all studies.Conclusions:There was no difference in SFR between PCNL and URS.Ureteroscopy was associated with a smaller stone burden and fewer and less severe complications.Ureteroscopy was found to be more effective than ESWL with a higher SFR and comparable safety profile.Further large-scale randomized controlled trials are needed to confirm these findings.

Strategies to optimizeshockwavelithotripsy outcome:Patient selection and treatment parameters

Shock wave lithotripsy(SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient- and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate.

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。

输尿管结石伴感染患者不同手术治疗时机的选择及作用分析

分析体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗无效的输尿管结石伴感染患者不同手术治疗时机的选择及其具体作用。选取2021年1月—2023年6月贵州省瓮安县人民医院经ESWL治疗无效的82例输尿管结石伴感染患者为研究对象,将患者按照不同手术治疗时机以及患者病情进行分组,分为两组,每组各41例。观察组患者在ESWL治疗无效后立即行逆行经尿道输尿管镜碎石取石术(ureteroscopic lithotripsy,URL)治疗,对照组患者在ESWL治疗无效后7天行URL治疗,比较两组患者治疗效果。结果显示,观察组患者治疗总有效率和结石清除率高于对照组(P<0.05),并发症总发生率低于对照组(P<0.05);术后,观察组患者IPSS评分低于对照组(P<0.05),血清学指标和生活质量评分优于对照组(P<0.05);观察组患者临床症状消失时间短于对照组(P<0.05)。研究发现,对ESWL治疗无效的输尿管结石伴感染患者立即行URL治疗,可提高结石清除率,减少术后并发症,改善患者前列腺症状和生活质量,缩短患者临床症状消失时间,优化患者血清学指标。

坦索罗辛配合输尿管镜下钬激光碎石术对输尿管结石患者的治疗效果

目的探讨坦索罗辛配合输尿管镜下钬激光碎石术在输尿管结石患者中的治疗效果。方法选取2021年12月至2023年10月万年县中医院收治的86例输尿管结石患者,按随机数字表法分两组,各43例。对照组予以输尿管镜下钬激光碎石术治疗,观察组术后加用坦索罗辛。对比两组结石排净率、尿路感染发生率、肾功能指标、临床症状积分、生活质量。结果观察组结石排净率高于对照组,尿路感染发生率低于对照组,尿素氮(BUN)、血肌酐(Scr)、腹部绞痛积分、尿频尿急积分、血尿积分、恶心呕吐积分均低于对照组,世界卫生组织生存质量测定量表(WHOQOL-100)中的心理评分、精神评分、环境评分、生理评分、社会关系评分、独立性评分、一般健康和生活质量评分均高于对照组(P<0.05)。结论坦索罗辛配合输尿管镜下钬激光碎石术可以增强排石效果,减少尿路感染,促进术后症状恢复,提高生活质量。

Present indications and techniques of percutaneous nephrolithotomy:What the future holds?

The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.

老年输尿管结石输尿管镜钬激光碎石术后泌尿系统感染的危险因素分析

目的分析老年输尿管结石输尿管镜钬激光碎石术后泌尿系统感染的危险因素。方法回顾性分析2016年1月至2017年1月于解放军第163医院行输尿管镜钬激光碎石术治疗的98例老年输尿管结石患者的临床资料,包括性别、年龄、基础疾病、结石位置、结石直径、手术时间及术前尿白细胞数、发热情况、尿细菌培养情况、预防性使用抗生素情况。将其中38例术后发生泌尿系统感染的患者纳入感染组,余60例患者未发生泌尿系统感染纳入未感染组。比较两组患者的临床资料,分析术后发生泌尿系统感染的危险因素。结果术后泌尿系统感染主要与女性、结石直径≥13 mm、手术时间≥60分钟、术前尿白细胞数≥45个/ml、术前发热及术前尿培养阳性有关(P<0.05);与年龄、结石位置、基础疾病、术前预防性使用抗生素情况无关(P>0.05)。多因素Logistic回归分析显示,术前发热、术前尿培养阳性、手术时间≥60分钟是老年输尿管结石患者术后发生泌尿系统感染的独立危险因素(P<0.05)。结论术前发热、术前尿培养阳性、手术时间≥60分钟是老年输尿管结石患者输尿管镜钬激光碎石术后泌尿系统感染的独立危险因素,临床中应在控制感染的基础上再行手术治疗,缩短手术时间,从而降低术后泌尿系统感染风险。

软性输尿管镜下激光碎石术后感染并发症的危险因素分析

目的调查软性输尿管镜下激光碎石术后感染危险因素,同时评估术前尿培养物中病原体的分布和耐药率。方法回顾性收集2013年6月-2017年6月于本院接受软性输尿管镜激光碎石术的500例肾结石患者,术前对所有患者进行尿培养,尿培养阳性的患者进一步鉴定病原菌的多重耐药性。根据是否发生术后感染并发症将患者分为感染组45例和非感染组455例。比较两组患者的临床资料,对相关指标进行Logistic回归分析,分析感染危险因素。结果 500例结肾结石患者软性输尿管镜下激光碎石术后,45例发生术后感染并发症,发生率为9.0%。感染组与未感染组的性别、年龄、BMI、结石位置、结石手术史均无统计学差异(P>0.05),但两组在糖尿病史、结石大小、术前尿培养结果、手术时间和住院时间方面具有统计学差异(P<0.05)。尿培养阳性患者共69例,感染病原菌中革兰氏阴性菌多于革兰氏阳性菌。根据病原菌多重耐药分析结果,将术前尿培养阳性患者分为多重耐药组和非多重耐药组,两组病原菌分布无统计学差异(P>0.05),但多重耐药组的耐药率显著更高(P<0.001)。多因素Logistic回归分析发现,术前尿培养阳性-多重耐药菌感染是软性输尿管镜下激光碎石术后感染的独立危险因素(P=0.005)。结论术前尿培养阳性-多重耐药病原菌感染是软性输尿管镜下激光碎石术后感染并发症的重要危险因素。术前尿培养阳性患者感染的病原菌中,革兰氏阴性菌多于革兰氏阳性菌。

输尿管软镜钬激光碎石术治疗上尿路结石近期疗效及术后院内感染相关因素分析

目的探讨输尿管软镜钬激光碎石术治疗上尿路感染的近期疗效及术后院内感染的危险因素。方法收集127例行输尿管软镜钬激光碎石术治疗的上尿路结石患者的临床资料,依据患者术后是否发生院内感染分为感染组(n=25)与非感染组(n=102),应用单因素及多因素Logistic回归分析院内感染相关因素。结果入组患者结石清除率为94.5%,发生院内感染25例(19.7%),以泌尿系统感染(64.0%)为主,共培养菌株37株,以感染革兰阴性菌(73.0%)为主。感染组女性、合并糖尿病、肾结石、术前尿路感染、重度肾积水、肾盂内压>30 mmHg、手术时间≥60 min患者比例显著高于非感染组(P<0.05)。性别、合并糖尿病、尿路感染、肾积水程度、肾盂内压、手术时间为输尿管软镜钬激光碎石术后发生院内感染的危险因素(P<0.05或0.01)。结论输尿管软镜钬激光碎石术治疗上尿路结石患者效果显著,结石清除率高,女性、术前合并尿路感染、重度肾积水、肾内压较高、合并糖尿病、手术时间延长的上尿路结石患者术后有更高的院内感染风险,应给予相应干预措施。

克淋通胶囊在上尿路结石术后抗感染疗效观察

目的:观察克淋通胶囊在上尿路结石术后抗感染的效果,明确其抗感染的有效性及安全性。方法:回顾分析980例上尿路结石术后患者资料,其中PCNL、URL、f-URL及ESWL分别为300例、220例、100例及360例,将每种治疗方法术后均分为克淋通胶囊组及热淋清组(对照组),治疗2周为一疗程。结果:入组患者共980例,有效完成956例,克淋通胶囊组480例,热淋清组(对照组) 476例。疗效显示克淋通与热淋清的痊愈率分别为26. 7%和16. 7%;总有效率分别为64. 0%和54. 2%,分别具有统计学意义(P<0. 05)。结论:克淋通胶囊可用于治疗上尿路结石术后感染,效果肯定、安全。

微创经皮肾镜治疗上尿路结石并感染

目的探讨微创经皮肾镜治疗输尿管上段结石及肾结石并感染的疗效。方法对感染较轻的肾、输尿上段结石并感染者,经控制感染后Ⅰ期行微创经皮肾镜术9例;合并较严重感染者先期行经皮肾造瘘、Ⅱ期微创经皮肾镜碎石取石术32例。结果Ⅰ期行微创经皮肾镜碎石取石术9例中,2例术后出现高热(>39℃),2例术后体温为38～39℃,其余5例术后体温<38℃。Ⅱ期经皮肾镜碎石取石术32例,所有病例Ⅱ期经瘘道碎石取石术后体温均<38℃。结论对于输尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常、无腰痛、估计手术时间不长者,选择Ⅰ期经皮肾镜碎石取石术;反之,选择Ⅱ期经皮肾镜术。

肾结石输尿管软镜碎石术后尿路感染病原菌分布特点及危险因素分析

目的分析肾结石输尿管软镜碎石术后尿路感染的病原菌分布特点及相关危险因素。方法选择2017年5月—2020年5月南通大学附属南京江北人民医院泌尿外科收治的行输尿管软镜碎石术肾结石患者189例作为研究对象,根据患者是否存在尿路感染将其分为感染组43例与非感染组146例,分析尿路感染的病原菌分布特点,采用多因素Logistic回归分析尿路感染的独立危险因素。结果43例肾结石术后尿路感染患者尿液中共分离培养出病原菌62株,其中革兰阴性菌38株(61.29%),检出率较高的有大肠埃希菌(24.19%)、铜绿假单胞菌(16.13%)、肺炎克雷伯菌(8.06%);革兰阳性菌16株(25.81%),检出率最高的为肠球菌(11.29%);真菌8株(12.90%),检出率最高的为白色念珠菌(6.45%)。多因素Logistic回归分析结果显示,术前尿白细胞>2个/HP、术前留置输尿管支架、术前未应用抗生素、中重度肾积水、手术时长>60 min、术后输尿管导管留置时长>7 d、合并糖尿病是肾结石术后尿路感染的独立危险因素(P均<0.05)。结论肾结石术后尿路感染患者病原菌多以大肠埃希菌、铜绿假单胞菌、肠球菌为主,存在多种独立危险因素。

经皮肾镜下气压弹道碎石与超声碎石术治疗感染性肾结石疗效对比

目的对比经皮肾镜下气压弹道碎石术与超声碎石术治疗感染性肾结石的临床疗效.方法2010年1月至2012年10月就诊的68例感染性肾结石患者,按随机数字表分成观察组34例和对照组34例.观察组采用经皮肾镜下气压弹道碎石术治疗,对照组采用超声碎石术治疗.比较两组结石清除率、手术时间、住院时间以及两组术中及术后并发症.结果观察组32例尿道结石完全清除,结石清除率为94.12%;对照组有26例结石完全清除,结石清除率为79.47%,两组比较差异有统计学意义（P〈0.05）.观察组的手术时间、术中出血量和住院时间为（1.35±0.45）h、（75.3±9.9） ml和（6.5±2.1）d,对照组分别为（1.48±0.55）h、（79.3±12.6）ml和（6.3±1.8）d,两组比较,差异无统计学意义（P〉0.05）.观察组术后出现并发症2例,并发症发生率为5.88%;对照组术后出现并发症5例,并发症发生率为14.71%.两组比较差异无统计学意义（χ2=1.433,P〉0.05）.结论经皮肾镜气压弹道碎石术优于超声碎石术,是一种治疗感染性结石的损伤小、恢复快、结石清除率高的方法.