Analysis Of The Effect Of Flexible Ureteroscopy Lithotripsy After The Failure Of ESWL Treatment For Upper Ureteral Stones

Objective:Upper ureteral calculi is one of the most common diseases and frequently occurring diseases in the urology.Extracorporeal Shock Wave Lithotripsy(ESWL)and Flexible ureteroscopy lithotripsy(FURS)are common treatment methods for upper ureteral calculi.The purpose of this study is to analysis the clinical data of patients treated with FURS after the failure of the ESWL treatment for upper ureteral calculi,the factors influencing the treatment effects of ESWL,and treatment effects of FURS in the upper ureteral calculi after the failure of the ESWL treatment.Methods:Retrospectively collected data of patients treated with FURS after the failure of the ESWL treatment for upper ureteral calculi in Wuxi City People’s Hospital from July 2017 to December 2019 as an observation group,and concurrent patients with upper ureteral calculi<20mm treated with FURS were used as the control group.Collect the patient’s age,gender,height,weight,stone diameter,stone surface area,average and maximum CT value of stones,degree of separation of renal pelvis,ureter wall thickness and CT value of ureter wall,renal function indexes before and after surgery(GFR,Scr,BUN,Cys-c),operation time,postoperative complications and other indicators.SPSS26.0 software was used for data processing to analyze the effect of ESWL treatment on ureteroscopy surgery,to further investigate whether there was a difference in the operation time between the two groups,and to conduct univariate analysis on the indicators that may affect the operation time.Measurement data was expressed by x±s,independent sample t test was used,P<0.05 was considered statistically significant,and count data was tested byc~2test,P<0.05 was considered statistically significant.According to the single-factor analysis and dissenting results,multi-factor logistic regression analysis was conducted to obtain the factors that affected the operation time.Results:Observation group:The success rate of primary lithotripsy was95.1%(39/41).Two patients failed to undergo lithotripsy due to ureteral stenosis.After indwelling the double J tube for 4 weeks,they were cured by ureteroscopic holmium laser lithotripsy.After 4 weeks of operation,after KUB review the clearance rate of stones was 95.1%(39/41).There were 2 cases of residual stones>4mm after the review.Drug-assisted stone removal treatment was continued.Control group:The success rate of primary lithotripsy reached 98%(49/50).One patient failed to operate due to ureteral stenosis.After indwelling the double J tube for 4 weeks,he was cured by secondary FURS.2 patients Because of the large stones,the operation was not successful in one operation.After 4 weeks,the patient was cured with a second FURS.After 4 weeks,the clearance rate of stones was 96%(48/50).One patient had residual stones>4mm.Continue to give drugs to assist stone removal treatment.There was no difference between the two groups of patients in the age,BMI,stone diameter,stone surface area,hydronephrosis,and renal function before surgery,although there was no difference in the success rate of one-time surgery,the rate of stone clearance after surgery and postoperative complications However,the average CT value of stones,ureteral change,ureteral wall thickness,ureteral wall CT value,and operation time were statistically significant;single factor analysis showed BMI,stone diameter,stone surface area,hydronephrosis,average CT value of stones,ureteral changes And ureteral wall thickness are the influencing factors of operation time;Logistic regression analysis shows that the degree of hydronephrosis,ureteral wall thickness and ureteral changes are independent influencing factors of operation time.Conclusion:After the failure of ESWL treatment for upper ureteral stones,FURS does not affect the therapeutic effect and safety;within the scope of ESWL and FURS indications,ESWL can be used as the first choice,and FURS can be used to make up after the failure of ESWL treatment.There are many factors affecting the operation time of FURS in upper ureteral stones,including BMI,stone diameter,stone surface area,hydronephrosis,average CT value of stones,ureter wall thickness,and whether they are treated with ESWL.All these factors must be considered before surgery to avoid surgery If the time is too long,it will increase the risk of patients.