Retrograde And Antegrade Ureteroscopic Pneumatic Lithotripsy For Treatment Of Kidney And Ureter On The Efficacy Of The Ureteral Stone

Objective：Explore the retrograde ureteroscopic pneumatic lithotripsy (URSL) andantegrade ureteroscopic pneumatic lithotripsy (mPCNL) treatment of kidney, ureteron the efficacy of the ureteral stone.Methods:Treatment from December2006to December2011in Qinghai ProvincePeople’s Hospital, Urology, kidney, ureteral stones in patients with110cases,include84males,26females.Clinical manifestations: the aching or discomfort of pars lumbalwere35patients, hematuria were21cases, urinary irritation symptoms were11cases.URSL group(58cases,44males,14females, aged20-78years old, average50.10±13.00years), and there was no case merger with the same side kidneystones,while combined with contralateral kidney stones were5patients, and stoneswere located between L3-L5level, mild renal insufficiency were4cases, combinedwith20cases of high blood pressure,9cases of diabetes,5cases of coronary heartdisease.mPCNL group of52cases,40males and12females, aged18-72years old(49.80±11.30) years of age, the ipsilateral upper ureteral stone with kidney stones,stones in thewaist2-L5level between mild renal35cases of water, moderatehydronephrosis in10cases,7cases of severe hydronephrosis,16cases ofhypertension, diabetes and8cases,4cases of coronary heart disease.The preoperativetests (routine blood, urine, biochemical, blood clotting and infectious diseases, etc),electrocardiogram, chest radiograph, urinary color dopplar ultrasound, abdominal CT,intravenous pyelogram (KUB+IVP) and urine power inspection were conducted, thebody temperature and the amount of urine were recorded, conventional antibiotic wasused2-3days, if obvious preoperative infection was exist, given a treatment actively,and underwent surgery after the infection controled.Comparing the perioperative andpostoperative materials related to URSL group and mPCNL (the clearance rate ofcalculus, operation time, peri-operative bleeding and postoperative fever, the length ofstay, etc.), comparing the count materiasl with chi-square test, measurement datas with the t-test to make the statistical analysis, P <0.05indicates differences with astatistical significance.Results: Of58cases who underwent URSL, succeed in45cases, the clearance rateof calculus was77.59%(45/58), there were10cases stones were immigrated to renalpelvis in the process of surgery, in which seven cases switched to mPCNL,3casesreplaced by open surgery,3cases rerouted to open surgery because the ureteralstricture found in the operation, and the stones were completely removed finally,therewere1cases appeared temporary fever,fell to normal after anti-infection treatment;1cases urinary leak,1case subcutaneous emphysema,cured after symptomatic treatment beforepatient discharged from hospital.Operation time was72.41±14.62min, peri-operativebleeding was6.10±0.97ml, average hospitalization time was5.10±1.38d.Of52cases underwent mPCNL,50cases achieved stone-free at one session, the clearancerate was96.15%（50/52）,there were2cases rerouted to open surgery because thesmeared field caused by massive haemorrhage intraoperatie during the surgery,1casedamaged the pleura during the establishing of percutaneous renal access,given thetreatment of thoracocentesis.there were3cases of late-occurred hemorrhage,givenroutine treatment (absolute bed rest、hemostasis、blood transfusion,etc), bleedingstopped gradually. There was3cases of postoperative fever, cured finally after givenantibiotics treatment,the others were succeed in clearance of stones.Operation time127.43±36.20min, peri-operative bleeding142.30±40.31ml, average hospitalizationtime11.60±2.46d.Conclusions: The two kinds of operation has respective advantages anddisadvantages.the clearance rate and complication of mPCNL is superior to URSL,but in aspects of operation time, peri-operative bleeding and the length of stay, etc,URSL is preponderant commensurate. Although the larger mPCNL trauma, there is arisk of postoperative delayed bleeding,etc., but in dealing with obstructive renalfailure and severe hydronephrosis in the upper ureteral calculi, the ipsilateral renalpelvis stones, with URSL irreplaceableadvantage.