Flexible Ureteroscope Holmium Laser Iithotripsy For The Treatment Of Upper Ureteral Stones After Failed MET

Backgurond:Since ancient times come, urinary stones as an ancient disease had never faded from the history of mankind.In recent years, the incidence of urinary stones has increased, it has become one of the world’s three major stones rage. Domestic urinary calculi incidence rate of about 1% to 5%, the South up to 5%-10%, the annual rate of about 150-200 new cases/10 million, of which approximately 25% require stay in hospital to be treated.Urolithiasis as a life-long disease, has high recurrence rate,10-year recurrence rate of about 50%, with a median onset of about nine years during the two disease happen.By now,renal and uretral calculus become the biggest ill in the Urologic disease and in people. Statistics show that ureteral calculus in the upper urinary tract calculi ratio is about 60%to 70%, the proportion of urinary calculus in total is about 30% -50%.Three ureteral stenosis are the most likely incarcerated stone sites,but in fact,stones most likely remain in the ureter near the level of the third lumbar vertebra and its vicinity.It often caused by renal calculus fall into the ureter to form, extremely rare primary in the ureter.Since the 1980s and 1990s,with the advances in imaging technology, success rate of early diagnosis of ureteral calculi gradually increased, provide a reliable basis for treatment.All kinds of treament apperas. Extracorporeal shock wave lithotripsy (ESWL) firstly appeared and has almost replaced the original conservative treatment and open stone surgery. Then laparoscopic surgery ureterolithotomy (LUL), Ureteroscopy lithotripsy (URL), percutaneous nephrolithotomy lithotripsy (PCNL) and other minimally invasive treatment come into being with the development of endoscopy and endoscopic techniques.They change the traditional treatment and make the treatment of minimally invasive therapies take bigger and bigger place in morden treatment.Significantly reduced the proportion of open surgery.However, so far the urinary stones for treatment and prevention there is no uniform standard, the choice between different hospitals around the stone treatment options there are still some differences.Face to the paitent who had upper ureteral calculus and renal calculus,how to clean the stones by one safely and effectively surgery is worthed to be discussed.In this study, ureteral soft holmium laser surgical treatment of MET failed patients, explore the reference for clinical practice has practical significance.Objective:Obseve and analysis the effect of flexible ureteroscope holmium laser surgical treatment effect on MET failed upper ureteral stone patients, explore its practical application in clinical therapy.Methods:From Jan 2011 to November 2014,Urology Department in Qilu Hospital which is belonged to Shandong University treated 60 paitents with upper uretal stones after MET failed by flexible ureteroscope holmium laser jontly treatment.450mg oral medication patients were twice/day×7 days, and no stone discharge.Were given blood, urine, urine culture and other routine examination, abdominal plain film, urinary B ultrasound, intravenous urography, retrograde urinary tract radiography, computed tomography and other imaging studies. The operation time, one gravel success rate, complication rate, average length of stay and other aspects of indicators are collected to analysis the application in clinical of flexible ureteroscope holmium laser surgical treatment.Results:Of these,60 cases were successful,no blood transfusion and noureteral perforation. Complication occurred in 6 cases and 1 case had double J tobe displacement.No perioperative mortality.After 7 days,no postoperative residual stones found by KUB.Operation time 40-80 minutes,mean 49 minutes;Gravel-time successful 58 cases,2 cases of ureteral too narrow, indwelling double J tube two weeks then surgery again successful;the average hospital stay of 4 days.4-6 weeks later referral, review the ultrasound, no residual stones and removal of ureteral stents. After discharge follow-up, renal function, hydronephrosis marked improvement.Conclusion:Flexible ureteroscope holmium laser therapy to upper ureteral stones after MET failed is minimally invasive, safe, high success rate and low complication.A reasonable means of treatment with clinical application for upper ureteral calculic after MET failed.