| Objective:It is to study the efficacy and safety of two different surgical positions of transurethral ureteroscopy pneumatic lithotripsy in the treatment of upper ureteral calculi.Methods: The clinical data and postoperative follow-up data of patients with upper ureteral calculi who underwent transurethral ureteroscopic pneumatic lithotripsy between January 2018 and December 2021 in the First Affiliated Hospital of Wannan Medical College were retrospectively reviewed.Surgical options were chosen after evaluation according to the patient’s wishes as well as their tolerance to the surgical body position and were divided into lateral and lithotomy position groups,in which the procedures in each group were performed by the same attending physician,and the stone expulsion was judged by reviewing the urinary ultrasound 1 month after surgery.Statistical data were analyzed by SPSS statistics for sex,age,stone size,left and right location of the stone,preoperative symptoms(nausea and vomiting,renal colic,macroscopic hematuria),operative time,stone-free rate in the first postoperative month,operative complications(postoperative fever,flank pain,macroscopic hematuria),postoperative hospital stay,intraoperative stone escape rate in a comparative study between the two groups,And univariate and multivariate analysis of factors influencing the effect of surgery.Results:According to the inclusion and exclusion criteria,a total of 317 patients were included in this study,133 in the lateral position group and 184 in the lithotomy position group;220(69.4%)were male and 97(30.6%)were female;Age range 21-82 years,mean age 49.30 ± 11.41 years;Stone size 0.6-1.5 cm,mean 1.08 ± 0.20 cm;168 patients(53.0%)had left ureteral stones and 149 patients(47.0%)had right ureteral stones;86 patients(27.1%)had preoperative nausea and vomiting,158 patients(49.8%)had preoperative complicated renal colic,123 patients(38.8%)had preoperative complicated macroscopic hematuria,248 patients(78.2%)had no hydronephrosis and mild hydronephrosis,and 69 patients(21.8%)had moderate and severe hydronephrosis.There were 89(66.9%)men and 44(33.1%)women in the lateral position group and131(71.2%)men and 53(28.8%)women in the lithotomy position group;The age ranged from 22 to 77 years with a mean of 49.78±11.04 years in the lateral position group and from 21 to 82 years with a mean of 48.95±11.68 years in the lithotomy position group;Stone size was 0.6-1.5 cm with a mean of 1.11±0.19 cm in the lateral position group and 0.6-1.5 cm with a mean of 1.05±0.21 cm in the lithotomy position group;Seventy one patients(53.4%)with left ureteral stones in the lateral position group,62(46.6%)with the right side,97(52.7%)with the left side and 87(47.3%)with the right side in the lithotomy position group;31 patients(23.3%)had preoperative combined nausea and vomiting in the lateral position group and 55 patients(29.9%)in the lithotomy position group;There were 68 patients(51.1%)with preoperative complicated renal colic in the lateral position group and 90 patients(48.9%)in the lithotomy position group;Forty six patients(34.6%)had preoperative gross hematuria in the lateral position group and 77 patients(41.8%)in the lithotomy position group;The lateral position group had 108 patients(81.2%)with no and mild hydronephrosis preoperatively and 25 patients(18.8%)with moderate and severe hydronephrosis;The lithotomy position group had 140 patients(76.1%)with no and mild hydronephrosis preoperatively and 44 patients(23.9%)with moderate and severe hydronephrosis.There were no significant differences in gender,age,left and right location of stones,or Preoperative complications(nausea and vomiting,renal colic,macroscopic hematuria,and degree of hydronephrosis)between the two groups(P > 0.05).The difference in stone size between the two groups was statistically significant(P < 0.05).The average operation time was 50.71±10.30 min in the lateral position group and53.24 ± 10.28 min in the lithotomy position group;14 cases(10.5%)in the lateral position group and 40 cases(21.7%)in the lithotomy position group had stones escaping during operation;The average hospital stay was 26.20±4.09 h in the lateral position group and 27.14±4.16 h in the lithotomy position group;Postoperative fever was found in 26 cases(19.5%)in lateral position group and 50 cases(27.2%)in lithotomy position group;Postoperative pain occurred in 14 patients(10.5%)in the lateral position group and 56 patients(30.4%)in the lithotomy position group;There were 10 cases of gross hematuria(7.5%)in the lateral position group and 39 cases(21.2%)in the lithotomy position group;127 cases(95.5%)in lateral position group and151 cases(82.1%)in lithotomy position group had no stones one month after the operation.There were statistically significant differences between the two groups in operation time,postoperative hospital stay,intraoperative stone escape rate,stone-free rate one month after the operation,postoperative low back pain,and postoperative gross hematuria(P<0.05).There was no significant diffe rence in postoperative fever between the two groups(P>0.05).Univariate and multivariate logistic regression analysis of the influencing factors of the stone-free rate in one month after operation showed that the operation position,operation time,stone size,hydronephrosis degree,and stone escape rate during operation were the independent influencing factors of the stone-free rate in one month after operation(P < 0.05).In addition,there were no serious complications such as massive hemorrhagic shock,ureteral perforation and ureteral laceration in both groups after operation.Conclusion:Transurethral pneumatic lithotripsy using lateral position and lithotomy position both are feasible,safe and effective treatments for upper ureteral calculi.Compared with the lithotomy position group,the operation time in the lateral position group was shorter,the stone escape rate during the operation was low,the incidence of postoperative complications was low,and the stone removal rate one month after operation was high.Transurethral pneumatic lithotripsy in lateral position can improve the success rate and efficiency of surgery,reduce the occurrence of surgical complications,and reduce the use of additional equipment and economic burden. |
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