Efficacy And Safety Of Flexible Ureterorenoscopy And Holmium Laser Lithotripsy In The Treatment Of Patients With Renal Calculi

Objective:Urolithiasis is a common disease in urological diseases which has high incidence and influences a wide range of population.Studies show that 5-15%people suffer from urolithiasis worldwide,among whom the Chinese patients occupy about 1-5%.Kidney stones are the most common stones in the urinary tract,and the degree of pain is also the highest in the urinary calculi.Due to the new rapid life style,more and more young people has no time to drink enough water in their daily lives,and also because of the irregular life and long term sitting,more and more renal calculus cases appear in young populations.Studies show that long term renal calculus that has not been treated in time will cause a series of problems.It will not only let the stones stay at ureteropelvic junction,but along will bring heavily pain to the patients,as well as influence other functions like leading to renal dysfunction and uremia.Renal tissues in patients with kidney stones will gradually be replaced by adipose tissues,in some of the severe cases,few of patients’ renal tissues left,even disappeared.At the same time,stones often contain lots of germs or other pathogens which will lead to kidney infection,hydronephrosis and pyonephrosis to make the symptoms more severe.Recently,flexible ureteroscope has been developed with the development of medical technology.Though combination of urology idea and industrial design,flexible ureteroscope and its new derivative products like electronic microscope,holmium laser,robot assisted soft ureteroscope,disposable ureter soft mirror,terminal flexible ureter mirror and double channel ureter soft mirror all have improved the treatment of urinary disease to a new level.Though there are some studies focusing on flexible ureteroscope,to be a new treatment method,it still need more clinical data to prove its efficacy.Thus in this study,we aimed to investigate efficacy and safety of flexible ureterorenoscopy and holmium laser lithotripsy in the treatment of patients with renal calculi.Methods:The study retrospectively analyzed 48 cases who underwent flexible ureterorenoscopy and holmium laser lithotripsy in Zhejiang university medical school affiliated first hospital during 2015 to 2016 Among the patients,there were 29 males and 19 females with the mean age 44.9±8.51 years(22-65),mean course of disease 14.35±6.72d(2-40).35 cases went to hospital due to low back or waist pain,6 cases due to hematuria and others were with no symptoms but were diagnosed by physical examination.All patients were diagnosed to be renal calculus using B ultrasound,KUB and CT.All stone type was unilateral calculus with 26 cases in left and 22 cases in right,among which 15 cases were in superior calyx,21 cases were in middle renal calyx and 12 cases were in inferior calyx.The mean diameter of the stones was 2.82±0.96cm(2.1cm-5.5cm).The study excluded patients with serious heart and lung disease or kidney dysfunction;effects of renal diseases,such as diabetes,chronic nephritis,hypertension patients;urinary tract infection,hydronephrosis,severe urethral stricture and staghorn calculi patients and other serious systemic disease.Flexible ureterorenoscopy and holmium laser lithotripsy was used to remove the stones and KUB was used to determine the outcome.The success rate to put flexible ureterorenoscopy,the rate of stone finding,the total clearance rate,the operation time,the amount of intraoperative bleeding,postoperative hospital stay and complications were recorded and analyzed.Results:1.Mean operation time between patients of superior calyx and middle renal calyx showed no significant difference,however the operation time of inferior calyx was significantly longer,P<0.05.Mean intraoperative blood loss showed no significant difference among all patients.2.Flexible ureterorenoscopy was put successfully at one time in 40 cases(83%)among all patients,superior calyx 13 cases(87%),middle renal calyx 18 cases(86%)and inferior calyx 9 cases(75%)which was significantly lower than the other two groups,P<0.05.Stones were found in all cases.3.Among all patients,stones were removed at one time in 41 cases(85%),superior calyx 14 cases(93%),middle renal calyx 19 cases(90%)and inferior calyx 8 cases(67%)which was significantly lower than the other two groups,P<0.05.4.Mean hospitalization time was 3.21±0.73d(1-8)for all patients,mean catheter remaining time was 1.72±0.33d(1～2)and mean sent removing time was 29.45±3.42d(15～30).All patients recovered well after surgery,5 cases of postoperative fever(10%),6 cases of postoperative side back pain(13%),3 cases of postoperative hematuria(6%),no serious complications.Conclusion:Flexible ureterorenoscopy and holmium laser lithotripsy has good efficacy and is very safe in the treatment of patients with renal calculi.