ObjectiveTo investigate the clinical efficacy and safety of lithotripsy under flexible ureteroscope using 200 μm holmium laser for medullary sponge kidney stones. MethodsWe identified and retrospectively reviewed 10 patients who underwent flexible ureteroscopic lithotripsy for medullary sponge kidney calculi between January 2013 and July 2014. The remission of clinical symptoms and incidence of perioperative complications were observed. ResultsThe staged surgery was performed on 10 bilateral cases with one session for each kidney. The operative time of our cohort was 130-180 minutes. The postoperative average hemoglobin was not significantly reduced (110.6 g/L) as compared with preoperative average hemoglobin (116.8 g/L) (P>0.05). Two patients had fever after operation and temperatures became normal by anti-infection. The renal function and plain film of kidney-ureter-bladokr (KUB) and CT scan were rechecked for all cases on three months after operation. The kidney function in 3 cases of chronic renal failure was ameliorated to varying degrees. The postoperative average of serum creatinine (196.2 μmol/L) was reduced as compared with the preoperative average serum creatinine (385.7 μmol/L) (P<0.05). Six patients reported spontaneous discharge of residuary stones during three months after surgery. KUB and CT scan proved significant reduction of the loads of stones for all cases after operation. ConclusionFlexible ureteroscope with 200 μm holmium laser lithotripsy is a safe and effective treatment for medullary sponge kidney stones based on its effect on amelioration of symptom and renal function.
ObjectiveTo investigate the necessity of indwelling ureteral stent before flexible ureteroscopic lithotripsy in the treatment of upper urinary tract calculi. MethodsEighty-five patients with upper urinary tract calculi treated between June 2013 and December 2014 were divided into two groups:group A (without indwelling stent, n=42) and group B (with indwelling stent, n=43).Incidence of stent-related urinary tract symptoms, operation time, one-time success rate of placement for ureteral access sheath, and stone clearance rate were compared between the two groups. ResultsThe operation time and stone clearance rate had no statistically significant differences between the two groups (P > 0.05).The incidence of stent-related urinary tract symptoms and one-time success rate of placement for ureteral access sheath in group B were significantly better than those in group A (P < 0.05). ConclusionFor one-phase operation success, we suggest that indwelling ureteral stent is necessary before flexible ureteroscopyic lithotripsy for treating upper urinary tract calculi.
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.