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 st...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.展开更多
To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,pe...To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,percutaneous nephrolithotomy in PubM ed,Scopus and Ebsco.We found approximately twenty suitable articles about this subject since January 1980 until January2014.All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added.In many studies,it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same,but percutaneous nephrolithotomy has less hospital stay time,duration of surgery and it is more cost effective.Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic展开更多
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 hospita...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.展开更多
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 u...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.展开更多
The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave...The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi;Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.展开更多
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=10...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。展开更多
目的分析经皮肾镜联合输尿管软镜取石术(RIRS)治疗输尿管结石合并同侧肾结石的应用优势。方法选取2020年1月—2023年1月150例输尿管结石合并同侧肾结石患者,随机分为2组各75例,肾镜组行经皮肾镜取石术(PCNL),双镜组采用PCNL联合RIRS。比...目的分析经皮肾镜联合输尿管软镜取石术(RIRS)治疗输尿管结石合并同侧肾结石的应用优势。方法选取2020年1月—2023年1月150例输尿管结石合并同侧肾结石患者,随机分为2组各75例,肾镜组行经皮肾镜取石术(PCNL),双镜组采用PCNL联合RIRS。比较2组围术期指标、术后并发症发生率、术后视觉模拟评分法(VAS)评分及尿液代谢异常发生率,术前及术后神经源炎症反应指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、C反应蛋白(CRP)、P物质(SP)]、肾功能指标[血清肌酐(Cr)、尿素(UREA)、肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)]。结果双镜组手术时间、住院天数短于肾镜组,术中出血量低于肾镜组,术后3 d、术后1个月结石清除率高于肾镜组(P<0.01)。双镜组术后并发症发生率为2.67%(2/75)低于肾镜组的12.00%(9/75)(P<0.05)。双镜组术后6、12、24、48 h VAS评分低于肾镜组(P<0.05)。双镜组术后24、48 h NGF、PGE_(2)、CRP及SP均低于肾镜组(P<0.05)。术后1周、2周双镜组Cr、UREA、KIM-1及NGAL低于肾镜组(P<0.05)。双镜组术后2周高尿酸尿症、高草酸尿症、低枸橼酸尿症、高钙尿症及低镁尿症发生率均较肾镜组低(P<0.05)。结论PCNL联合RIRS治疗输尿管结石合并同侧肾结石患者可优化手术操作,抑制神经源炎症反应,减轻术后疼痛与肾功能损伤,且能提高结石清除率,降低并发症风险,改善尿液代谢状态。展开更多
文摘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.
文摘To investigate the best treatment option for large upper ureteral stone,percutaneous nephrolithotomy or laparoscopic ureterolithotomy.We searched three key word of upper ureteral stone,laparoscopic ureterolithotomy,percutaneous nephrolithotomy in PubM ed,Scopus and Ebsco.We found approximately twenty suitable articles about this subject since January 1980 until January2014.All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added.In many studies,it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same,but percutaneous nephrolithotomy has less hospital stay time,duration of surgery and it is more cost effective.Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic
文摘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.
文摘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.
文摘The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi;Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.
文摘目的: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。
文摘目的分析经皮肾镜联合输尿管软镜取石术(RIRS)治疗输尿管结石合并同侧肾结石的应用优势。方法选取2020年1月—2023年1月150例输尿管结石合并同侧肾结石患者,随机分为2组各75例,肾镜组行经皮肾镜取石术(PCNL),双镜组采用PCNL联合RIRS。比较2组围术期指标、术后并发症发生率、术后视觉模拟评分法(VAS)评分及尿液代谢异常发生率,术前及术后神经源炎症反应指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、C反应蛋白(CRP)、P物质(SP)]、肾功能指标[血清肌酐(Cr)、尿素(UREA)、肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)]。结果双镜组手术时间、住院天数短于肾镜组,术中出血量低于肾镜组,术后3 d、术后1个月结石清除率高于肾镜组(P<0.01)。双镜组术后并发症发生率为2.67%(2/75)低于肾镜组的12.00%(9/75)(P<0.05)。双镜组术后6、12、24、48 h VAS评分低于肾镜组(P<0.05)。双镜组术后24、48 h NGF、PGE_(2)、CRP及SP均低于肾镜组(P<0.05)。术后1周、2周双镜组Cr、UREA、KIM-1及NGAL低于肾镜组(P<0.05)。双镜组术后2周高尿酸尿症、高草酸尿症、低枸橼酸尿症、高钙尿症及低镁尿症发生率均较肾镜组低(P<0.05)。结论PCNL联合RIRS治疗输尿管结石合并同侧肾结石患者可优化手术操作,抑制神经源炎症反应,减轻术后疼痛与肾功能损伤,且能提高结石清除率,降低并发症风险,改善尿液代谢状态。
