Application Of Ureteral Catheter In The Treatment Of Ureteral Calculi With Stricture

Objective: Ureteral calculi are a high incidence disease in China,which can cause ureteral obstruction.Even if the calculi are small,it may be difficult to discharge after conservative treatment and a series of clinical symptoms can occur in the human body.Ureteral stricture is often found in patients undergoing endoscopic surgery,which brings some challenges to the treatment.This paper discusses the application of ureteral catheter in the treatment of middle and lower ureteral calculi with ureteral stricture by ureteroscopy and evaluate the efficacy of two different methods.Methods: A retrospective study was conducted on 59 cases of middle and lower ureteral calculi admitted to the third affiliated hospital of Nanchang university from August 2017 to October 2019.Preoperative complete ultrasound of urinary system,KUB,urologic CT,and judge the stone position,size.Making clear the surgical indications,completing the preoperative examination,and eliminating surgical contraindications.Baseline data of patients were collected,including patient basic information(age,height,weight,gender),medical history(history of ipsilateral ureteroscopy,history of extracorporeal shock wave lithotripsy,fever,urinary tract infection,hematuria),ureteral stone position and size,etc.The study included 32 male cases and 27 female cases,the youngest case was 27 years old and the oldest 82 years old,the shortest clinical symptoms history ere 2 hours,the longest clinical history was 3 years,and 6 case were asymptomatic.In the study,there were 26 cases of right lesion,33 cases of left lesion,51 cases of middle and lower ureteral stricture,and 8 cases of open stricture.Ureteral stricture was found during ureteroscopy,and adopting the ureteral catheter auxiliary treatment or the ureteroscope dilates directly,set as A,B group respectively.The efficacy of the two surgical methods was compared by the postoperative success rate of the two groups,the calculi clearance rate followed-up for one month,the operative time,the clear time of urine after operation,the incidence of complications and other indicators,and the postoperative pain degree was evaluated by visual analogue scale.Results: The baseline data of patients in group A and group B were comparable(P > 0.05).Finally,47 cases successfully completed ureteroscope lithotripsy,the operation time was 39(29~64)min in group A and 46(36.5~71)min in group B(P = 0.139);the clear time of urine after operation was 3(1~4)d in group A and 3.5(2~4)d in group B(P = 0.114);the postoperative pain score was 3(2~4)in group A and 2(2~3)in group B(P = 0.169).Group A success rate of surgery [28(90.3%)] was higher than group B [19(67.9%)] patients(P = 0.032).The unsuccessful patients were treated with extracorporeal shock wave lithotripsy and ureterolithotomy after the implantation of DJ tube,and returned to the hospital after one month to remove the DJ tube and review the calculi.The results indicated that there was no statistical difference in stone clearance rate between group A [29(93.5%)] and group B [25(89.3%)],P = 0.661.All patients did not appear Clavien Ⅴ level of complications(death),no serious complications occurred in group A,one case occurred Clavien Ⅲ level of complications(severe bleeding)in group B,the rest of the patients’ blood loss were very few,and two groups of the total incidence of complications were no statistical differences(P = 0.427).Conclusion: Ureteral catheter auxiliary treatment of ureteral calculi with ureteral stricture can avoid the blindness of the direct expansion,with high security,short operation time,low complication rate,less blood loss,less equipment requirements,low medical treatment cost,and higher success rate of ureteroscopy.For patients with middle and lower ureteral calculi accompanied by benign ureteral stricture and short stenosis segment,ureteral catheter auxiliary treatment has certain curative effect can be achieved.