The Clinical Application And Effect Analysis Of FURSL In Treatment Kidney Calculi After ESWL Is Ineffective

Objective: To compare the clinical applications of the use of remedial flexible ureteroscopic lithotripsy(FURSL)after the failure of extracorporeal shock wave lithotripsy(ESWL)with simplex FURSL for calculi that are less than or equal to 2cm,and applied stone-free rate(SFR),complications and Operation time(OT)as the analysis of clinical effect.Methods: To collected altogether 73 cases of patients whose calculi were less than or equal to 2cm treated with FURSL from July 2015 to June 2017 in Anhui Medical University of Wuxi Clinical College.Among those cases,the patients who were treated with FURSL after the failure of ESWL are 41(group ESWL-FURSL),and 32 cases treated with simplex FURSL(group FURSL).2 weeks after EWSL,reexamined KUB or CT to detect the SFR.If the residual calculi which were less than or equal to 6 mm can use ESWL once more(≤3 times).If there were residual calculi,FURSL should be considered.Before FURSL,Double J tube should be put for 2 or 4 weeks.Results: A total of 73 cases with renal calculi ≤2cm were included in this study.Group ESWL-FURSL: A total of 41 cases,including male 23 cases,female 18 cases,age 29-73 years old,average 50.3 years old.Among them,11 cases of renal pelvis,18 cases of the upper middle kidney,12 cases of the next calculus,the stone diameter was 9.34~19.60 mm,the average(14.88±3.30mm).Group FURSL: A total of 32 cases,including male 15 cases,female 17 cases,age 29~76 years old,average 51.8 years old.Among them,8 cases of renal pelvis,13 cases of the upper middle kidney,11 cases of the next calculus,the stone diameter was 7.12~19.23 mm,the average(13.65±3.50mm).The OT of group ESWL-FURSL and group FURSL were(88.56±30.47)min VS(85.78±24.27)min.The hospital stays after operation were(5.05±2.05)d VS(4.75±2.95)d,but the differences were not statistically significant(t= 0.422,p=0.67;z=-0.809,p=0.42).The postoperative complication in all was 13.7%(10/73),4 cases of fever occurred in ESWL-FURSL Group and 3 cases of urosepsis,In Group FURSL,there were 1 cases of fever,1 cases of renal week hematoma and 1 cases of urosepsis.All the patients recovered symptomatic treatment,but the differences were not statistically significant(p=0.54).The SRF in ESWL-FURSL Group and FURSL Group after operation was 82.9%(34/41)VS 87.5%(28/32),the differences were not statistically significant(p=0.83).The employed FURSL for the second time was 14.6%(6/41)VS 9.4%(3/32),the differences were not statistically significant(p=0.75).Reexamined by CT one month later,it showed that all stones had been discharged.Conclusion: After ESWL failure,remedial treatment of FURSL is safe and reliable,in SRF,operation complication and FURSL treatment effect is similar,ESWL does not increase FURSL complication,and recommended FURSL as a first-choice remedy after ESWL is ineffective.