Clinical Efficacy And Safety On Upper Urinary Tract Stones By Shuo Tong Ureteroscopy(Report Of 23 Cases)

Background and Objective:Urinary calculi is one of the most common urinary diseases in the clinic.Its incidence rate is 1%-5%,while the incidence rate is as high as 5%-10%in the south;The recurrence rate is as high as 50%in 10 years.With the improvement of economic level and the change of dietary nutrition structure,the incidence of urinary calculi is increasing year by year,which makes our country one of the three major areas of lithiasis in the world.And with the rapid development of medical devices,imaging and electronic engineering technology,there are more and more methods for the treatment of the urinary calculi,including:external physical vibration lithecbole(EPVL),extracorporeal shock wave lithotripsy(ESWL),ureteroscopic lithotripsy(URL),retrograde intrarenal surgery(RIRS),Shuo Tong ureteroscopy,percutaneous nephrolithotomy(PCNL),laparoscopic pyelolithotomy,etc.At present,ureteroscopic lithotripsy widely used in clinical practice is one of the most important surgical treatments for the upper urinary tract calculi with the advantages of effective?non-invasive and relative safety.However,ureteroscopic lithotripsy can not be used for clearing the stone fragments,especially for the large stones,which will affect the visual field of the operation.But both of these can be achieved by Shuo Tong ureteroscopy.Shuo Tong ureteroscopy is a new technique that has just been implemented to treat the upper urinary tract calculi in our province.The clinical data of patients with the upper urinary tract calculus undergoing Shuo Tong ureteroscopy in our hospital from September 2017 to February 2018 was retrospectively analyzed to evaluate the efficacy and safety of Shuo Tong ureteroscopy.Materials and methods:The clinical data of 23 patients with upper ureteral calculi or kidney calculi treated by Shuo Tong ureteroscopy at Department of Urology,the Second Affiliated Hospital of Zhengzhou University from September 2017 to February 2018 was retrospectively analyzed.Of the 23 patients,11 were males and 12 females,with the mean age of(48.3±9.3)years old(range 30-68).All of them were unilateral upper urinary tract calculi:10 cases of upper ureteral calculi,10 cases of renal pelvis calculi,1 cases of upper ureteral complicated with renal pelvis calculi,2 cases of renal pelvis calculi complicated with the upper calyx calculi;Among them,13patients with hydronephrosis(10 cases with mild hydronephrosis,2 cases with moderate hydronephrosis,and 1 case with severe hydronephrosis);The mean diameter of calculi of all patients was(1.76±0.38)cm(range 1.2-2.8).The data including postoperative hospital stay,stone clearance rates,hemoglobin loss,change in serum creatinine on the first postoperative day,peripheral leukocyte count,PCT,IL-6,postoperative complications such as fever and sepsis were compared and analyzed.The data were analyzed by SPSS 21.0.The measured data with normal distribution were expressed as mean±standard deviation.The comparison between the two samples was performed using t-test and the difference was statistically significant at P<0.05.Results:Shuo Tong ureteroscopy was inserted successfully in all patients.Among them,9 cases(39.1%)of combined retrograde intrarenal surgery during operation.The mean postoperative hospital stay was 2.6 days(range 2-7);The stone free rate was respectively 82.6%(19/23)and 91.3%(21/23)on the first postoperative day and 30days after the operation.The mean preoperative hemoglobin was(127.7±16.2)g/L of all patient,and postoperative(122.5±16.3)g/L,the differences between preoperative and postoperative hemoglobin are statistically significant(P<0.05).The mean preoperative serum creatinine(64.2±14.6)mmol/L all patient and postoperative(66.5±14.8)mmol/L,the differences between preoperative and postoperative serum creatinine aren't statistically significant(P>0.05).The white blood cell count was lower than 3.5×10~9/L in 1 patient,and the white blood cell count was higher than 9.5×10~9/L in 2 patients.The level of PCT and IL-6 was elevated in patients with postoperative fever(?38.5°C).There were 3 cases(13.0%)of postoperative fever and 1 case(4.3%)of severe sepsis.No other serious postoperative complications were found.Among the 23 patients,calcium oxalate stones were found in 20 cases(87.0%),uric acid stones in 1 case(4.3%)and carbonate apatite stones in 2 cases(8.7%).Conclusions:1.Shuo Tong ureteroscopy is a feasible,relatively safe,effective minimally invasive surgery for the treatment of upper urinary tract calculi.2.Shuo Tong ureteroscopy can improve short-term stone clearance by clear stone during surgery.3.Shuo Tong ureteroscopy can reduce postoperative infection rate and the incidence of sepsis,but if not handled properly,it will increase the incidence of postoperative infection and sepsis.