Application Of PCNL Without Artificial Hydronephrosis Local Anesthesiain Upper Urinary Calculi With Mild Hydronephrosis

Objective:Urinary calculi is a common and frequently-occurring disease in urology.China is a high incidence area of stones in the world,with an incidence rate of 6.1%and an increasing trend.Percutaneous nephrolithotripsy(PCNL)is a common method for the treatment of upper urinary calculi.With the advancement of endoscopic technology and the update of operating equipment,PCNL has made great progress,and its safety and effectiveness have been continuously improved.With the deepening of the concept of rapid rehabilitation surgery,we tried to use local infiltration anesthesia for PCNL,and proved its safety and effectiveness in practice.It also reflects the advantages of local anesthesia such as convenience,efficiency and rapid recovery.In order to further optimize the operation process,we found in practice that for stones with moderate to severe hydronephrosis,the procedure of artificial hydronephrosis can be avoided during PCNL under local anesthesia,which is consistent with experts and scholars at home and abroad.However,it is still controversial whether artificial hydronephrosis is performed for upper urinary calculi with mild hydronephrosis.The purpose of this study was to compare the efficacy and safety of non-artificial hydronephrosis local anesthesia PCNL and artificial hydronephrosis local anesthesia PCNL in upper urinary tract calculi with mild hydronephrosis.Methods:The clinical data of patients who underwent B-ultrasound-guided local anesthesia PCNL in our hospital from September 2020 to October 2022 and met the inclusion criteria(renal calculi≥2cm or upper ureteral calculi above L4>1.5cm and combined with B-ultrasound diagnosis of mild hydronephrosis)were retrospectively analyzed.According to whether the patients underwent artificial hydronephrosis during the operation,they were divided into artificial hydronephrosis group and non-artificial hydronephrosis group.The stone free rate,first puncture success rate,intraoperative and postoperative VAS score,postoperative hospitalization time,rate of complications,hospitalization cost,hemoglobin change,serum urea nitrogen change,serum creatinine change and other data were collected and compared between the two surgical methods for the treatment of upper urinary calculi with mild hydronephrosis.Results:Finally,the data of 56 patients with mild hydronephrosis and upper urinary tract calculi who underwent local anesthesia PCNL were analyzed.The average operation time of the two groups was(44.38±20.44)vs(55.75±17.31)min and the intraoperative VAS score was 2(2,3)vs 3(3,4).The difference between the two groups was statistically significant(p<0.05).The stone free rate,the first puncture success rate and the rate of complications were 87.5%vs 91.6%,90.7%vs 83.3%and 12.5%vs 14.3%,respectively.There was no significant difference between the two groups(p>0.05).The stone free rate of upper ureter and ureteropelvic junction was 100%,and the first puncture success rate was 92.3%vs 100%.There was no significant difference in postoperative VAS score,postoperative hospitalization days,hospitalization expenses,hemoglobin change,serum urea nitrogen change and serum creatinine change between groups(p>0.05).Three pediatric patients with upper urinary calculi received PCNL without artificial hydronephrosis and successfully cleared the stones.In all cases,there were no serious complications such as severe infection,spleen injury,intestinal injury,pleural effusion,interventional embolization hemostasis,renal resection and death.Conclusions:For patients with upper urinary tract calculi with mild hydronephrosis,compared with artificial hydronephrosis,local anesthesia PCNL without artificial hydronephrosis has the advantages of shortening operation time and reducing intraoperative pain.It has no significant effect on stone clearance rate,one-time puncture success rate and complication rate,and has good efficacy and safety,especially for stones in the upper ureter and ureteropelvic junction.At the same time,PCNL without artificial hydronephrosis local anesthesia attempts to expand its indications,and gradually applied to children with upper urinary tract stones.