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 Re...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.展开更多
BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative di...BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.展开更多
BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract ...BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy(MPCNL)has a similar stone free rate(SFR)as standard percutaneous nephrolithotomy(S-PCNL).As a result,M-PCNL was also recommended as a treatment option for staghorn calculi.AIM To examine the perioperative and long-term results of ultrasonography-guided single-and M-PCNL.METHODS This was a retrospective cohort study.Between March 2021 and January 2022,the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy.The primary outcomes were com plication rate and SFR,and the characteristics of patients,operative parameters,laboratory measurements were also collected.RESULTS In total,345 patients were enrolled in the study(186 in the S-PCNL group and 159 in the M-PCNL group).The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group(P=0.033).Moreover,the incidence rates of hydrothorax(P=0.03)and postoperative infection(P=0.012)were higher in the M-PCNL group than in the S-PCNL group.Logistic regression analysis demonstrated that post-operative white blood cell count(OR=2.57,95%CI:1.90-3.47,P<0.001)and stone size(OR=1.59,95%CI:1.27-2.00,P<0.001)were associated with a higher overall complication rate in the S-PCNL group.Body mass index(OR=1.22,95%CI:1.06-1.40,P=0.004)and stone size(OR=1.70,95%CI:1.35-2.15,P<0.001)were associated with increased overall complications in the M-PCNL group.CONCLUSION Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.展开更多
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 ...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.展开更多
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 ...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.展开更多
Objective: To explore the comparative observation on nursing effect of nursing intervention and routine nursing in patients with renal calculi and gastric ulcer and the impacts on epidermal growth factor. Methods: A t...Objective: To explore the comparative observation on nursing effect of nursing intervention and routine nursing in patients with renal calculi and gastric ulcer and the impacts on epidermal growth factor. Methods: A total of 72 patients with renal calculi and gastric ulcer were selected and treated in our hospital from January 2018 to December 2018. They were divided into the observation group and the control group, 36 for each. Comprehensive nursing intervention was implemented in the observation group, whereas routine nursing was implemented in the control group. The level of epidermal growth factor, nursing satisfaction, renal calculi recurrence rate, average hospital stay and postoperative blood loss were compared between the two groups after nursing. Results: There was no significant difference in the level of epidermal growth factor between the two groups before nursing (P > 0.05), while after nursing, the level in the observation group was higher compared with the control group, and the difference between the two groups was significant (P Conclusion: With regard to patients with renal calculi and gastric ulcer, comprehensive nursing intervention can improve nursing satisfaction and quality of patients’ lives, reduce calculi recurrence rate, and increase the level of epidermal growth factor, which has clinical application value.展开更多
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 ...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.展开更多
AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large ...AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.展开更多
Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with th...Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.展开更多
Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected ac...Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.展开更多
<strong>Aim: </strong>To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. <strong>Materials and Methods:<...<strong>Aim: </strong>To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. <strong>Materials and Methods:</strong> This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. <strong>Results:</strong> We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). <strong>Conclusion:</strong> The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.展开更多
INTRODUCTION The presentation of cardiogenic shock(CS)is usually straightforward,and includes hypotension,absence of hypovolemia,and clinical signs of poor tissue perfusion such as oliguria,cyanosis,cool extremities a...INTRODUCTION The presentation of cardiogenic shock(CS)is usually straightforward,and includes hypotension,absence of hypovolemia,and clinical signs of poor tissue perfusion such as oliguria,cyanosis,cool extremities and altered mentation.^([1])展开更多
Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria.Although prostatic calculi are seen in chronic prostatitis,chronic pelvic pain syndrome and benign prostate hyperplasia,non...Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria.Although prostatic calculi are seen in chronic prostatitis,chronic pelvic pain syndrome and benign prostate hyperplasia,none of these have prostatic calculi or calcification as extensive as in alkaptonuria.A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.展开更多
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 tr...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.展开更多
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 retr...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.展开更多
Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and th...Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.展开更多
Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Mater...Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Materials and Methods: A total of 100 consecutive symptomatic patients with stones located in the Lower ureter were selected for the study who received oral tamsulosin 0.4 mg daily for 4 weeks and deflazocort 30 mg daily for 10 days and diclofenac IM/Oral on demand. Ultrasound follow-up and medical visits and X ray KUB were performed weekly for 4 weeks. Stone passage rate and time, pain episodes and endoscopical intervention were evaluated. Results: The stone expulsion rate was 87.8%. Mean stone size was 6.5 ± 2.14 mm. Mean expulsion time was 8 ± 1.84 days. Mean pain episodes were 1.50 ± 0.87 days. 11 patients needed intervention for stone retrieval. There was no statistically significant difference between the expulsion rates of right and left ureteral stones (P value = 0.31). Conclusions: Medical therapy with a combination of α<sub>1</sub> adrenergic blocker and corticosteroid achieve good stone expulsion rates, lower pain episodes and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy.展开更多
Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to Nov...Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.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
Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy ...Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.展开更多
文摘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.
文摘BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.
文摘BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy(MPCNL)has a similar stone free rate(SFR)as standard percutaneous nephrolithotomy(S-PCNL).As a result,M-PCNL was also recommended as a treatment option for staghorn calculi.AIM To examine the perioperative and long-term results of ultrasonography-guided single-and M-PCNL.METHODS This was a retrospective cohort study.Between March 2021 and January 2022,the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy.The primary outcomes were com plication rate and SFR,and the characteristics of patients,operative parameters,laboratory measurements were also collected.RESULTS In total,345 patients were enrolled in the study(186 in the S-PCNL group and 159 in the M-PCNL group).The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group(P=0.033).Moreover,the incidence rates of hydrothorax(P=0.03)and postoperative infection(P=0.012)were higher in the M-PCNL group than in the S-PCNL group.Logistic regression analysis demonstrated that post-operative white blood cell count(OR=2.57,95%CI:1.90-3.47,P<0.001)and stone size(OR=1.59,95%CI:1.27-2.00,P<0.001)were associated with a higher overall complication rate in the S-PCNL group.Body mass index(OR=1.22,95%CI:1.06-1.40,P=0.004)and stone size(OR=1.70,95%CI:1.35-2.15,P<0.001)were associated with increased overall complications in the M-PCNL group.CONCLUSION Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.
基金Supported by Project of Administration of Traditional Chinese Medicine of Hebei Province of China,No.2020048.
文摘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.
文摘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.
文摘Objective: To explore the comparative observation on nursing effect of nursing intervention and routine nursing in patients with renal calculi and gastric ulcer and the impacts on epidermal growth factor. Methods: A total of 72 patients with renal calculi and gastric ulcer were selected and treated in our hospital from January 2018 to December 2018. They were divided into the observation group and the control group, 36 for each. Comprehensive nursing intervention was implemented in the observation group, whereas routine nursing was implemented in the control group. The level of epidermal growth factor, nursing satisfaction, renal calculi recurrence rate, average hospital stay and postoperative blood loss were compared between the two groups after nursing. Results: There was no significant difference in the level of epidermal growth factor between the two groups before nursing (P > 0.05), while after nursing, the level in the observation group was higher compared with the control group, and the difference between the two groups was significant (P Conclusion: With regard to patients with renal calculi and gastric ulcer, comprehensive nursing intervention can improve nursing satisfaction and quality of patients’ lives, reduce calculi recurrence rate, and increase the level of epidermal growth factor, which has clinical application value.
文摘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.
文摘AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.
文摘Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.
文摘Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
文摘<strong>Aim: </strong>To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. <strong>Materials and Methods:</strong> This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. <strong>Results:</strong> We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). <strong>Conclusion:</strong> The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.
文摘INTRODUCTION The presentation of cardiogenic shock(CS)is usually straightforward,and includes hypotension,absence of hypovolemia,and clinical signs of poor tissue perfusion such as oliguria,cyanosis,cool extremities and altered mentation.^([1])
文摘Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria.Although prostatic calculi are seen in chronic prostatitis,chronic pelvic pain syndrome and benign prostate hyperplasia,none of these have prostatic calculi or calcification as extensive as in alkaptonuria.A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.
基金Supported by Health Medicine Science and Technology Plan Project of Zhejiang Province,China,No.2021KY603.
文摘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.
文摘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.
基金Science and technology department of Sichuan province(No.2017JY05012)
文摘Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.
文摘Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Materials and Methods: A total of 100 consecutive symptomatic patients with stones located in the Lower ureter were selected for the study who received oral tamsulosin 0.4 mg daily for 4 weeks and deflazocort 30 mg daily for 10 days and diclofenac IM/Oral on demand. Ultrasound follow-up and medical visits and X ray KUB were performed weekly for 4 weeks. Stone passage rate and time, pain episodes and endoscopical intervention were evaluated. Results: The stone expulsion rate was 87.8%. Mean stone size was 6.5 ± 2.14 mm. Mean expulsion time was 8 ± 1.84 days. Mean pain episodes were 1.50 ± 0.87 days. 11 patients needed intervention for stone retrieval. There was no statistically significant difference between the expulsion rates of right and left ureteral stones (P value = 0.31). Conclusions: Medical therapy with a combination of α<sub>1</sub> adrenergic blocker and corticosteroid achieve good stone expulsion rates, lower pain episodes and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy.
文摘Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.
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Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.
