Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.
Objective To assess the efficacy and safety of the tubeless approach with a ureteral stent versus nephrostomy tube for postoperative drainage following percutaneous nephrolithotomy, and to provide guidance for clinical practice. Methods Randomized controlled trials (RCTs) were identified from PubMed (1966 to August 2008), Ovid (1966 to August 2008), Embase (1966 to August 2008), The Cochrane Library (Issue 3, 2008) and CBM (1978 to 2008). We also handsearched for relevant published and unpublished reports and check their references. The quality of the included trials was evaluated by two reviewers. We used The Cochrane Collaboration’s RevMan 5.0.16 software for meta-analysis. Results Eight studies involving 507 patients were included. We divided the patients into three groups: small (8~9 Fr), medium (16~18 Fr) and large (20~24 Fr) according to the diameter of nephrostomy tube for the analysis. Our meta-analyses showed: ①Hospital stay (hours): There was no statistically significant difference between tubeless and small bore tubes, but a difference was found in the comparison of tubeless versus medium and large bore tubes [WMD (95%CI) –32.4 (–33.64, –31.16) and –39.07 (–67.75, –10.39), respectively]; ② Puncture site urinary leakage: No statistically significant difference was found between tubeless and small bore tubes, of between tubeless versus medium tubes [RR= 0.07, 95%CI (0.00, 1.15), P=0.06]; ③ Visual analogue scale scores for postoperative pain on Day 1: There was no statistically significant difference between tubeless and small bore tubes, but there was a difference in tubeless versus medium and large bore tubes [MD (95%CI) –2.80 (–2.94, –2.66) and –2.04 (–2.29, –1.79), respectively];④No statistically significant difference was found in transfusion, fever or infection and operating time between tubeless and any size of nephrostomy tube. Conclusion No statistically significant difference between tubeless versus small bore tubes is found for any of the outcome measurements we analysed. Compared with medium and large bore tubes, tubeless PCNL of ureteral stent could reduce hospital stay, urine leakage and postoperative pain without an increase in complications. There is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality randomized controlled trials is needed.
目的：探讨微创经皮肾穿刺取石术(MPCNL)治疗肾结石的疗效。方法：采用MPCNL治疗41例肾结石患者，其中肾石30例(结石直径gt;2.0 cm)，输尿管上段结石11例(结石直径1.0～2.0 cm)；单侧结石37例，双侧结石4例。结果：41例手术均获成功。手术时间45～120 min，平均52.7 min，无一例改开放手术。本组肾结石病例单次结石清除26例(86.7%)，4例残余结石行二期手术取净；输尿管上段单次结石清除率100%。结论：MPCNL 是一种有效的治疗肾结石的方法，并具有创伤小、取石率高、恢复快等优点。
ObjectiveTo evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi. MethodsWe retrospectively analyzed the data of 78 patients from August 2012 to February 2014 who underwent flexible ureteroscopic holmium laser lithotripsy in our hospital. Among them, calculi were located at the upper or middle calyx in 41 patients, at the lower calyx in 27, at the renal pelvis in 6, and at multiple calyxes in 4. The diameter of the stones ranged from 0.8 to 2.0 cm with a mean of 1.4 cm. The stones were fragmentized by using 200 μm holmium laser fiber. A follow-up by renal CT scan was done 4 weeks after the procedure to evaluate the rate of the stone clearance. ResultsThe calculi were detected in 76 patients (97.4%, 76/78). The success rate in one-session procedure was 94.9% (74/78). After 4 weeks, the total stone-free rate was 97.4% (74/76). The mean operative time was 30 minutes (20-55 minutes). The mean hospital stay of the patients was 3 days (2-6 days). Two cases were found to have lower back pain combined with fever and cured by anti-inflammatory treatment. Naked eye hematuria disappeared in our cases after operation for 1 to 2 days. Seventy-four cases were followed up from 4 to 16 months with a median time of 8 months and no recurrence was detected. ConclusionThe flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi, with a high discovery rate of stones, high success rate, high evacuation rate, few severe complications, short hospital stay and sustainable treatment.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of longer than 2 cm in diameter. MethodsFrom August 2012 to July 2014, 15 selected patients with renal calculi of longer than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. Preoperative indwelling ureteral stent was performed for 1-2 weeks, and super smooth guidewire was inserted after checking and dilation of the ureter was performed with F8.0/9.8 rigid ureterosope. Flexible ureteroscope sheath was inserted through guidewire. Ureterosope was followed by flexible ureteroscope sheath. Larger stone fragments were removed by basket. ResultsThe success rate of ureteroscopic insertion was 100% and no severe intraoperative complications occurred. The operation time ranged from 50 to 125 minutes averaging 75. No ureteral perforations or pyonephrosis or acute renal insufficiency occurred. Four patients had high fever after operation and improved after positive anti-infection treatment. After 2 days, the stone-free rate was 73.3% (11/15) by reviewing KUB. The follow-up of 4 weeks showed the stone-free rate was 86.7% (13/15). One case of stone fragments retained in the middle and lower ureter and the fragments were taken out by ureteroscopic lithotripsy. The other case of renal residual calculi was operated by flexible ureteroscope holmium laser lithotripsy in two stage. ConclusionFlexible ureteroscopic lithotripsy is a favorable option for patients with renal stones of longer than 2 cm in diameter, especially for recurrent renal calculi.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for patients with renal calculi of more than 2 cm in diameter. MethodsThe Clinical data of 37 patients with renal calculi of more than 2 cm in diameter treated with holmium laser lithotripsy through flexible ureteroscope between December 2012 and March 2015 were retrospectively analyzed. In this group, stone diameter was between 2.0 cm and 3.5 cm, including 22 cases of single stone and 15 cases of multiple stones. Preoperative ureteral stents were indwelt in all the patients for 1-2 weeks. After dilation of the ureter with F8/9.8 rigid ureteroscope, the ureteral access sheath for flexible ureteroscope was inserted to the target ureter followed by flexible ureteroscope. Stones were fragmentized by holmium laser and the power was not more than 30 W (1.0-1.5 J/15-20 Hz). ResultsThe success rate of ureteroscopic insertion was 100% (37/37). The operation time ranged from 40 to 185 minutes with a mean of 73 minutes. After the operation, one patient had sepsis, and was cured after positive anti-infection treatment. No other serious complications occurred. Four and 8 weeks after surgery, the free-stone rate was 73.0% (27/37) and 86.5% (32/37) respectively. ConclusionThe flexible ureteroscopic lithotripsy is advantageous in less trauma, fewer complications, quick recovery and higher free-stone rate. It can be used to treat renal calculi of over 2 cm in diameter selectively.
ObjectiveTo evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy (SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals.MethodsThe clinical data of 64 patients with unilateral kidney calculi (CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People’s Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy (MPCNL). The pre-, intra-, and post-operative data were compared and analyzed to evaluate the efficacy and safety.ResultsThe unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups (P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs. (25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs. (9.44±0.96) days], rate of indwelling renal fistula (3.3% vs. 50.0%), analgesic demand rate (10.0% vs. 58.8%), and postoperative infectious fever rate (6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant (P<0.05).ConclusionsSMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.