Clinical Study Of Retrograde Ureteroscopy Lithotripsy In The Treatment Of Impacted Ureteral Calculi

Objective:To discuss the treatment effect of retrograde holmium laser lithotripsy in treatment of impacted ureteral calculi, and to analyze the effect of surgery-related factors. Methods:128cases of patients with ureteral calculi in our hospital were divided into two groups. The cases of unimpacted ureteral calculi group was70, the group of impacted ureteral calculi was58. Comparison of efficacy and operation complications of holmium laser lithotripsy for two groups, and to analyze the failure reasons of impacted ureteral stones, and the relationship between surgery effect and different locations and different size of impacted ureteral stones. Results:The stone clearance rate, operative time and postoperative incidence of gross hematuria in the unimpaction group and the impaction group was91.4%(64/70) and74.1%(43/58),(36.3±10.7)min and (45.2±13.9)min,.51.4%(36/70) and84.5%(49/58), respectively(P<0.05). The postoperative hospital stay, analgesics utilization rate, urinary tract infection rates and ureteral perforation rate in the unimpaction group and the impaction group was (1.5±1.2)d and (1.9±1.4)d,1.4%(1/70) and6.9%(4/58),7.1%(5/70) and12.1%(7/58),0(0/70) and6.9%(4/58), respectively(P>0.05).6cases were surgical failure in the unimpaction group, mainly due to the move of ureteral calculi during the operation.15cases were surgical failure in the impaction group, mainly due to the stone fragments move, the ureter excessive distortion, ureteral stricture, ureteral perforation, large and hard stones. There were32cases of pathological changes associated with ureteral wall visually in impaction group, in which22cases of significant ureteral mucosal edema,6cases of ureteral wall granulation or polyps,4cases of ureteral stricture. The success rate was58.3%of the stones that was above the level of L4in the impaction group, while the success rate was85.3%of the stones that was below the level of L4in the impaction group(P<0.05). The surgical success rate of impaction group was63.6%(7/11) and53.8%(7/13), respectively, about the stone diameter>1cm and≤1cm above the level of L4(P>0.05),and the surgical success rate was78.9%(15/19) and93.3%(14/15) respectively, below the level of L4. The surgical success rate of impacted group was57.1%(8/14) and60%(6/10), respectively, in the group of mild and severe hydronephrosis above the level of L4(P>0.05), and the surgical success rate of impaction group was81.3%(13/16) and88.9%(16/18), respectively, below the level of L4(P>0.05). Conclusion:Impacted ureteral calculi than unimpacted stone is more difficult to deal, the main factors including stone fragments move and ureter distorting. The impacted ureteral calculi can be combined with ureteral wall edema, inflammatory granulation and polyps, ureteral stricture. The operation success rate of impacted stones above the level of L4is less than below. There may not are significant relationship between degree of hydronephrosis and the size of impacted stones and the lithotripsy success rate.