Etiology and management of urethral calculi:A systematic review of contemporary series

Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.

Self-supervised learning artificial intelligence noise reduction technology based on the nearest adjacent layer in ultra-low dose CT of urinary calculi

Objective To observe the value of self-supervised deep learning artificial intelligence(AI)noise reduction technology based on the nearest adjacent layer applicated in ultra-low dose CT(ULDCT)for urinary calculi.Methods Eighty-eight urinary calculi patients were prospectively enrolled.Low dose CT(LDCT)and ULDCT scanning were performed,and the effective dose(ED)of each scanning protocol were calculated.The patients were then randomly divided into training set(n=75)and test set(n=13),and a self-supervised deep learning AI noise reduction system based on the nearest adjacent layer constructed with ULDCT images in training set was used for reducing noise of ULDCT images in test set.In test set,the quality of ULDCT images before and after AI noise reduction were compared with LDCT images,i.e.Blind/Referenceless Image Spatial Quality Evaluator(BRISQUE)scores,image noise(SD ROI)and signal-to-noise ratio(SNR).Results The tube current,the volume CT dose index and the dose length product of abdominal ULDCT scanning protocol were all lower compared with those of LDCT scanning protocol(all P<0.05),with a decrease of ED for approximately 82.66%.For 13 patients with urinary calculi in test set,BRISQUE score showed that the quality level of ULDCT images before AI noise reduction reached 54.42%level but raised to 95.76%level of LDCT images after AI noise reduction.Both ULDCT images after AI noise reduction and LDCT images had lower SD ROI and higher SNR than ULDCT images before AI noise reduction(all adjusted P<0.05),whereas no significant difference was found between the former two(both adjusted P>0.05).Conclusion Self-supervised learning AI noise reduction technology based on the nearest adjacent layer could effectively reduce noise and improve image quality of urinary calculi ULDCT images,being conducive for clinical application of ULDCT.

Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi:A case report

BACKGROUND In the clinical treatment of diseases related to ureteral duplication,it is very important to make a clear diagnosis before surgery because different types of ureteral duplication correspond to different treatment options.Inverted Y ureteral duplication with ectopic ureters and multiple urinary calculi is clinically rare.This case can help clinicians increase their understanding of this disease and gain some experience in its diagnosis and treatment.CASE SUMMARY A 36-year-old male who was previously healthy presented to the hospital with lumbar pain.Percussion of the right kidney area showed the patient had pain.Computed tomography scans revealed multiple urinary calculi in the right urinary system.Computed tomography urography revealed a duplicated ureteral malformation with an ectopic ureter.A transurethral ureteroscopic holmium laser lithotripsy was performed successfully.Intraoperative retrograde ureterography was performed,and the ectopic ureter was visible.We informed the family of the intraoperative findings and suggested laparoscopic ectopic ureterectomy for the ectopic ureteral stones.Unfortunately,the family temporarily refused laparoscopic surgery.The patient did not feel any discomfort after one year of followup.CONCLUSION Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi is rare.Clinicians must be highly vigilant,make a correct diagnosis before surgery,determine the type of ureteral duplication and the distribution of urinary calculi,and then draw up a reasonable treatment plan to avoid unnecessary complications.

Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal;however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.

Risk factors of concurrent urinary sepsis in patients with diabetes mellitus comorbid with upper urinary tract calculi

BACKGROUND Urinary sepsis is frequently seen in patients with diabetes mellitus(DM)complicated with upper urinary tract calculi(UUTCs).Currently,the known risk factors of urinary sepsis are not uniform.AIM To analyze the risk factors of concurrent urinary sepsis in patients with DM complicated with UUTCs by logistic regression.METHODS We retrospectively analyzed 384 patients with DM complicated with UUTCs treated in People’s Hospital of Jincheng between February 2018 and May 2022.The patients were screened according to the inclusion and exclusion criteria,and 204 patients were enrolled.The patients were assigned to an occurrence group(n=78)and a nonoccurrence group(n=126).Logistic regression was adopted to analyze the risk factors for urinary sepsis,and a risk prediction model was established.RESULTS Gender,age,history of lumbago and abdominal pain,operation time,urine leukocytes(U-LEU)and urine glucose(U-GLU)were independent risk factors for patients with concurrent urinary sepsis(P<0.05).Risk score=0.794×gender+0.941×age+0.901×history of lumbago and abdominal pain-1.071×operation time+1.972×U-LEU+1.541×U-GLU.The occurrence group had notably higher risk scores than the nonoccurrence group(P<0.0001).The area under the curve of risk score for forecasting concurrent urinary sepsis in patients was 0.801,with specificity of 73.07%,sensitivity of 79.36%and Youden index of 52.44%.CONCLUSION Sex,age,history of lumbar and abdominal pain,operation time,ULEU and UGLU are independent risk factors for urogenic sepsis in diabetic patients with UUTC.

经皮肾镜取石术分期治疗结石性脓肾临床效果的Meta分析

目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国知网、万方、维普数据库,于2012年1月—2022年10月发表的有关于结石性脓肾研究的文章,并根据纳入和排除标准选择文献。在检索数据并评价文献质量后,采用Review Manager software(RevMan 5.4.3,Cochrane协作网,Oxford,UK)进行Meta分析。结果本文从105项研究中选择了11项共688例患者。其中347例接受Ⅰ期PCNL治疗,341例患者接受Ⅰ期PCN及Ⅱ期PCNL治疗(以下简称Ⅱ期PCNL)。Meta分析结果显示:Ⅰ期PCNL和Ⅱ期PCNL在结石清除率(P=0.95)、手术时间(P=0.48)、术后感染性休克(P=0.36)、肾周积液感染(P=0.27)方面差异无统计学意义;Ⅰ期和Ⅱ期PCNL在术后发热(P=0.03)、留置肾造瘘管时间(P<0.01)、住院费用(P<0.01)、住院时间(P<0.01)、术后住院时间(P=0.02)方面差异有统计学意义。对于结石性脓肾患者的治疗,以上2种方案在结石清除率、手术时间、术后发生肾周积液感染及感染性休克的发生方面类似。虽然Ⅰ期PCNL术后发热的患者更多,但是住院费用更低,留置肾造瘘管时间、总住院时间、术后住院时间更短。结论Ⅰ期PCNL治疗肾及输尿管上段结石合并脓肾是经济、安全、有效的,在临床实践中具备一定的推广价值。

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.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR URINARY CALCULI: 18 YEARS EXPERIENCE

Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney or ureter accepted ESWL. The kidney stones were sorted by FDA standard. The ureteric stone was sorted by its site and retrograde pyelography. At the same time, we summarized the recurrence of kidney stone and its relationship between extracorporeal shock wave lithotripsy （ ESWL ） and hypertension. Results The efficacy for class I kidney stone was 91.2% that for class II 86. 5% and class III 72.3% , the healing rate for ureteric stone was 84. 5%. Combined retrograde pyelography and ESWL couM improve the efficacy. If ESWL failed, the ureteric stone could still be removed by operation or ureterscopy （ 1.1% ）. The rate of recurrence of kidney stone was 6. 1% and the incidence of hypertension post-treatment reached 7. 9%. Conclusion ESWL is a preferred approach to treat urinary calculi.

Percutaneous nephrolithotomy for treating upper urinary calculi under local anesthesia(report of 1363 cases)

Objective To discuss the feasibility of pereutaneous nephrolithotomy ( PCNL) for treating upper urinary calculi under local anesthesia. Methods One thousand three hundred and sixty - three patients who suffered

Selection of staged or synchronous percutaneous nephrolithotomy for treatment of bilateral upper urinary tract calculi

Objective To evaluate the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy ( PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study

三金排石汤加减治疗泌尿系结石有效性与安全性的Meta分析

目的 系统评价三金排石汤加减治疗泌尿系结石的有效性与安全性。方法 检索中国知网(CNKI)、维普(VIP)、万方(WanFang)、中国生物医学文献数据库(CBM)、PubMed上的有关三金排石汤联合常规西医疗法(试验组)对比常规西医疗法(对照组)治疗泌尿系结石的临床随机对照研究,检索时限定为2010年1月1日~2023年12月1日。根据纳排标准进行文献筛选和数据提取,运用Review Manager 5.4软件进行Meta分析。结果 纳入符合要求的10篇随机对照研究,共1 286例患者,试验组648例,对照组638例。Meta分析结果:实验组的临床总有效率[OR=3.57,95%CI(2.28,5.60),P <0.000 01]、结石排出率[OR=4.00,95%CI(2.75,5.82),P <0.00001]、结石排出时间[MD=-5.78,95%CI(-9.54,-2.03),P=0.003]均优于对照组,且不良反应发生率[OR=0.32,95%CI(0.19,0.57),P<0.000 1]低于对照组。结论 三金排石汤对于泌尿系结石有较好的治疗效果且安全性较高。

一次性输尿管软镜与可重复使用输尿管软镜治疗上尿路结石有效性及安全性的Meta分析

目的评价一次性输尿管软镜(su-FURS)与可重复使用输尿管软镜(ru-FURS)治疗上尿路结石时的有效性及安全性。方法通过计算机检索PubMed、Embase、Cochrane Library、万方、维普和中国知网等数据库,检索时间均为建库至2023年8月13日,收集采用su-FURS和ru-FURS治疗上尿路结石的随机对照试验(RCT)。应用Stata15.0软件对纳入的文献进行荟萃分析。结果共纳入8篇文献,累计1338例患者。Meta分析结果显示,su-FURS与ru-FURS治疗上尿路结石的结石清除率、手术时间、住院时间、术后血红蛋白下降值、并发症发生率比较,差异无统计学意义(P>0.05)。结论在治疗上尿路结石时,su-FURS与ru-FURS的有效性和安全性无明显差异,但采用su-FURS治疗的性价较高,值得推广应用。

后腹腔镜输尿管切开取石术与经输尿管镜取石术治疗老年上尿路结石患者的疗效及对血清ET-1、PGE_2、PGF_(2α)的影响

目的:探讨后腹腔镜输尿管切开取石术(RLU)与经输尿管镜取石术(URL)治疗老年上尿路结石患者的效果及对血清超敏C反应蛋白(hs-CRP)、内皮素(ET-1)、前列腺素E_2(PGE_2)、PGF_(2α)等指标的影响。方法:将2015年4月-2017年7月因上尿路结石于本院行手术治疗的90例患者纳入研究,并随机分为对照组与观察组,每组各45例。对照组采用URL术治疗,观察组采用RLU术,比较两组患者术前及手术5 d后hs-CRP及ET-1改善情况,PGE_2、PGF_(2α)等疼痛介质水平改善情况,及两组临床疗效差异。结果:观察组ET-1及hs-CRP等指标水平低于对照组,两组比较差异均有统计学意义(P<0.05);术后第5天观察组PGE_2、PGF_(2α)水平低于对照组(P<0.05);观察组一次性结石清除率97.78%高于对照组77.78%,两组比较差异有统计学意义(P<0.05);观察组并发症发生率2.22%低于对照组17.78%,两组比较差异有统计学意义(P<0.05)。结论:采用RLU治疗老年上尿路结石效果显著,创伤小,可降低疼痛介质,一次性结石清除率高,值得推广。

双能CT在体诊断泌尿系统尿酸盐和草酸盐结石的Meta分析

目的采用Meta分析探讨双能CT对体内尿酸盐结石及草酸盐结石的诊断价值。方法检索2005年1月—2015年12月中国学术期刊网络出版总库、维普期刊数据库、中国生物医学文献数据库、万方数据库、Cochrane图书馆、web of science、PubMed及Elsevier-SDOL,提取运用双能CT分析体内泌尿系结石成分的相关文献。采用诊断准确性研究的质量评价工具-2对纳入文献进行质量评估,Meta-disc 1.4软件进行Meta分析。结果纳入中英文文献共12篇。诊断尿酸盐结石汇总敏感度、特异度分别为0.97[95%CI为(0.91,0.99)]、0.99[95%CI为(0.98,1.00)];诊断草酸盐结石汇总敏感度、特异度分别为0.99[95%CI为(0.97,1.00)]、0.90[95%CI为(0.85,0.93)]。结论双能CT诊断体内尿酸盐、草酸盐结石具有较高的敏感度和特异度,有助于指导临床选择治疗方案。

α1受体阻滞剂用于ESWL后排石有效性的Meta分析

目的系统评价α1肾上腺素能受体阻滞剂用于体外冲击波碎石技术(ESWL)后辅助排石的有效性。方法以Urinary calculi、Alpha-blocker、Randomized clinical trail、Extracorporeal shockwave lithotripsy等为检索词,计算机检索Pub Med、Embase、Cochrane图书馆、CNKI等数据库,系统收集α1受体阻滞剂用于ESWL后辅助排石的相关研究文献。对纳入的文献进行筛选及质量评价,提取数据后,以Revman5.0软件进行Meta分析,完成综合定量。结果本次研究共纳入14篇随机对照实验文献,累计病例1 464例。结果表明应用α1受体阻滞剂后结石排出率提高(RR=1.21,95%CI:1.10~1.33,P<0.05);结石排出平均时间缩短(SMD=-1.23,95%CI:-2.09^-0.36),P<0.05);但对于缓解腹绞痛发作的效果仍缺乏足够的支持(RR=0.54,95%CI:0.28~1.02,P=0.06)。结论α1受体阻滞剂用于ESWL后可有效提高结石排出率,缩短结石排出时间,可作为ESWL术后辅助排石治疗方法。

坦索罗辛联合丁溴东莨菪碱辅助体外冲击波碎石治疗泌尿系结石效果及安全性的meta分析

目的系统评价坦索罗辛联合丁溴东莨菪碱在泌尿系结石体外冲击波碎石(ESWL)后辅助排石的效果及安全性。方法计算机检索中国知网、万方、VIP、CBM、PubMed、Cochrane Library、Web of Science核心合集数据库,检索时限从建库至2022年4月,查找坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石的随机对照试验,试验组ESWL后给予坦索罗辛+丁溴东莨菪碱,对照组ESWL后给予丁溴东莨菪碱。采用RevMan 5.4软件进行meta分析,分析两组有效率、排石时间、肾绞痛消失时间、疼痛评分及不良反应情况,其中根据排石时间单位选择分为小时组、天数组;根据评分量表选择分为视觉模拟评分法(VAS)组、数字疼痛评分法(NPRS)组。结果共纳入8篇文献,1762例患者。试验组有效率高于对照组(RR=1.21,95%CI:1.16,1.26,P<0.00001)。小时组排石时间短于对照组(SMD=-5.50,95%CI:-6.59,-4.41,P<0.00001)。天数组排石时间短于对照组(SMD=-4.21,95%CI:-6.40,-2.03,P=0.0002)。试验组肾绞痛消失时间短于对照组(SMD=-2.04,95%CI:-2.18,-1.91,P<0.00001)。VAS组疼痛程度低于对照组(SMD=-0.65,95%CI:-0.90,-0.39,P<0.00001)。NPRS组疼痛程度低于对照组(SMD=-1.59,95%CI:-1.80,-1.38,P<0.00001)。两组不良反应比较,差异无统计学意义(P>0.05)。结论坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石可以提高治疗的有效率,促进结石排出、缩短疼痛时间及减轻患者疼痛症状,是一种安全有效的方法。

复方金钱草颗粒治疗泌尿系结石术后的有效性和安全性的Meta分析

目的:系统评价复方金钱草颗粒治疗泌尿系结石术后的有效性和安全性。方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、the Cochrane Library、Embase和Wed of Science,搜集关于复方金钱草颗粒治疗泌尿系结石术后的随机对照研究。检索时限为建库至2023年1月。采用RevMan 5.4软件进行Meta分析。结果:共纳入10项研究。Meta分析结果显示,对于术后未留置双J管的患者,复方金钱草颗粒组的总有效率高于空白对照组,差异有统计学意义(RR=1.18,95%CI=1.09~1.27,P<0.0001);在常规治疗基础上联合复方金钱草颗粒对泌尿系结石患者术后国际前列腺症状评分(IPSS)(MD=-2.81,95%CI=-3.25~-2.36,P<0.00001)和膀胱过度活动症评分(OABSS)(MD=-3.48,95%CI=-5.64~-1.33,P=0.002)的改善效果优于单纯使用常规治疗,差异均有统计学意义;相比于空白对照、单纯抗感染治疗,复方金钱草颗粒单药及其联合抗感染治疗可以降低术后留置双J管患者术后并发症发生率,差异有统计学意义(RR=0.29,95%CI=0.12~0.72,P=0.008);与空白对照、左氧氟沙星比较,复方金钱草颗粒能缩短术后结石排出时间,差异均有统计学意义(P<0.05);与单纯抗感染治疗相比,术后加用复方金钱草颗粒患者的术后结石排出时间更短,差异有统计学意义(P<0.01)。结论:复方金钱草颗粒能够提高泌尿系结石术后患者的治疗总有效率,改善IPSS评分和OABSS评分,缩短术后结石排出时间,减少留置双J管引起的并发症,且没有明显的不良反应。

PCT、ET联合LPS检测在尿石症冲击波碎石术后尿路感染中的诊断价值

目的分析降钙素原(PCT)、内毒素(ET)联合脂肪酶(LPS)检测在尿石症冲击波碎石术后尿路感染中的诊断价值。方法收集2018年3月至2021年3月河北北方学院附属第一医院收治的经冲击波碎石术治疗的尿石症患者168例,统计患者术后感染情况,对比感染组与未感染组PCT、ET、LPS表达水平;对感染组患者治疗后1 d、7 d PCT、ET、LPS表达水平;对比不同感染菌患者中PCT、ET、LPS表达水平;分析PCT、ET、LPS对患者术后尿路感染的诊断价值。结果168例患者术后发生感染35例,未感染133例。35例术后感染者中14例为革兰阳性菌,21例为革兰阴性菌。感染组PCT、ET、LPS表达水平显高于未感染组,差异有统计学意义(P<0.05);治疗后7 d患者PCT、ET、LPS表达水平明显低于治疗后1 d,差异有统计学意义(P<0.05);革兰阴性菌组PCT、ET、LPS表达水平明显高于革兰阴性菌,差异有统计学意义(P<0.05);依据ROC曲线可知,PCT+ET+LPS联合检测对患者术后尿路感染诊断敏感度和特异度分别为0.800、0.857,AUC=0.840(95%CI:0.757~0.922),明显高于三者单独诊断(P<0.05)。结论尿石症冲击波碎石术后尿路感染患者PCT、ET、LPS表达水平明显升高,三者均可为术后尿路感染情况提供参考,且联合诊断可有效提高诊断效能。

Genetic Mutation of Vitamin K-dependent Gamma-glutamyl Carboxylase Domain in Patients with Calcium Oxalate Urolithiasis

To investigate the exon mutation of vitamin K-dependent gamma-glutamyl carboxylase （GGCX or VKDC） in patients with calcium oxalate urolithasis, renal cortex and peripheral blood samples were obtained from severe hydronephrosis patients （with or without calculi）, and renal tumor patients undergoing nephrectomy. GGCX mutations in all 15 exons were examined in 44 patients with calcium oxalate urolithiasis （COU） by polymerase chain reaction （PCR） and denatured high pressure liquid chromatography （DHPLC）, and confirmed by sequencing. Mutation was not found in all COU samples compared to the controls. These data demonstrated that functional GGCX mutations in all 15 exons do not occur in most COU patients. It was suggested that there may be no significant association between the low activity and mutation of GGCX in COU.