A Randomized Controlled Clinical Trials On Indwelling D-J Tube Before Flexible Ureteroscope Lithotripsy

OBJECTIVE: to compare the efficacy and safety of indwelling双J tube beforeFlexible ureteroscope lithotripsy.METHODS: From November2013to March2014,60kidney stone or Proximalureter stong patients who will be treated by Flexible ureteroscope lithotripsy,wererandomly divided into group A and B;Group A has30case which were directlyprocedured surgery,another group need to be indwelled a双J tube in ureter aweek,than were procedured surgery. Both groups need to be placed ureteralFlexibleureteroscope access sheath,if there have difficulties than we can expand the ureter.After opration,we analyzed and compared the proportion of the two groups of patientswho have to be expanded,and analyzed operative time,hospital stay, cost ofhospitalization, postoperative complications, stone clearance rate and so on.RESULTS: The issue of60patients were successfully conducted Phase Itransurethral flexible ureteroscope lithotripsy.Two groups of patients in surgery werenot found ureteral tear, ureteral mucosal degloving,rupture, perforation, andbleeding or other complications.There were six ureter had to be expended in groupA,Three cases which can not be expanded to F14using Ureter fascia dilator.Then weexpended the ureter to21F using ureteral balloon dilator. The remaining ureter ofthree cases could be expended to14F using Ureter fascia dilator.The Group B has onecase which had to be expended using Ureter fascia dilator.Disposable success rates of indwelling Flexible ureteroscope channel sheath in the two ureters were24/30(80%),29/30(96.67%),The difference between two rate was no statisticaldifference.The mean operative time of group A was78.3740.35min.Patients ofGroup B needed twice surgery,The first retrograde indwelling D-J tube in ureter underlocal anesthesia mean operative time was13.776.88min,Phase Ⅱmean operativetime was8032.85min,The total mean operative time was93.7736.03min,Theoperative time difference of two groups showed no statistical difference.All patientswere routinely indwelled a F6or F8double J tube in ureter.The stone-free rates ofgroup A and B in postoperative1-2days was18/30（60%）,17/30（56.67%）；And thestone-free rates in postoperative one month was29/30(96.67%)、28/30(93.33%).Thestone-free rates in postoperative1-2days and1month in the two groups, has nostatistical difference.No case of postoperative temperature exceed38.5℃in the twogroup,and no sepsis occured.All patients were not requiring transfusion because ofbleeding.The mean hospitalization costs of two group were19675.982880.03yuanand21060.566068.02yuan,There was no statistical difference in the meanhospitalization costs of two group.The hospitalization time of two group were6.71.74days and11.73.72days,it has significant statistical difference.One patientof group A appeared ureteral stone street in a month after surgery,then hospitalizedagain,further Implemented Ureteroscopic Lithotripsy.CONCLUSION: When possessing ureteral dilatation equipment(ureter fasciadilator and balloon dilator),The surgery is safe and effective conventional withoutindwelling ureteral double J tube in advance for1-2weeks before TransurethralFlexible ureteroscope lithotripsy.