Clinical Analysis Of Transureteroscopic Pneumatic Lithotripsy In The Treatment Of Ureteral Calculi

Objective: Urinary calculi is one of the common urological diseases, among which the ureteral calculi can reach 33% ~ 54%〔1〕. Urinary calculus is in high relapse rate and needs to be treated repeatedly. The open operation is the traditional surgery treatment. With the popularization of ureteroscopy and ripeness of clinicians, the technology of ureteroscopy shows great advantage in the treatment of ureteral calculi in clinic. The transureteroscopic surgery has become the first selection in the treatment of the middle and distal segmental ureteral calculi at present. But for upper ureteral calculi, the transureteroscopic surgery is the supplementary treatment for failure of extracorporeal shock wave lithotripsy (ESWL) therapy. This study aimed to evaluate the security and therapeutic effect of the transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi through the analysis of the clinical data of this treatment in our hospital.Methods: Retrospective analysis of the clinical data of 92 cases of ureteral calculi patients with transureteroscopic pneumatic lithotripsy treatment in the Second Affiliated Hospital of Dalian Medical University from August 2004 to December 2008. The case history and the purpose of ureteroscopy are clear. The laboratory and imaging examinations had finished and the contraindication was excluded before operation. Prophylactic antibiotics were used preoperatively. Combination block anaesthesia or general anesthesia was adopted. The patients were taken in lithotomy position with flat and abducted lower limb. The rigid ureteroscope F8～9.8 produced by Germany WOLF company was used to insert into the bladder under orthophoria, after finding the ureteral orifice, and then go directly into the ureter following the Zebra guide wire. Switch off the perfusion pumps after the stone was seen. Insert the metal specillum diametered 0.8 to 1.2mm through the working channel of ureteroscope. Press the stone against the wall of the ureter and switch on the compression pump (on the working pressure of 1.5～2.0 atmospheric pressure) to shattered the stone to the size below 2mm with continuous pulse. Remove the larger crushed stone with lithotomy forceps. Paragraphs of ureteral calculi in the success rate of lithotripsy statistical analysis. SPSS13.0 statistical software used for analysis, statistical methods using X2 test.Results: 86 cases were of successful surgery among 92 cases of stones in this group (the stones were crushed or removed with lithotomy forceps directly, and no resident stone larger than 2mm), the achievement ratio was 93.47%. The achievement ratio of the surgery of upper, middle and distal segmental ureteral calculi was 81.25% (13/16), 93.75% (30/32) and 97.72% (43/44) respectively. Six cases was not in successful surgery, of which one case adopted open stone surgery and polypectomy (ureteral calculus was located in the middle section of the ureter) because of the severe congestion by the polyps for the ureteroscope to insert in; one cases adopted the treatment of other methods for impaction of ureteroscopy by the prostate hyperplasia (the stone was located in the middle part of the ureter); one cases adopted open stone surgery and ureteral transplantation due to stricture and malformation of uretero-vesical orifice (the stone was located in the distal part of the ureter); Three cases with the stones moving upward to inferior major renal calices kidney on the under the lights (stones are located in the upper part of ureter). The majority of the patients showed mild hematuria and urinary tract irritation after a short period of time (1～3 days) with no serious complications such as ureteral perforation, laceration etc. Six cases appeared recurrent lumbodynia after bracket of ureter insertion but the symptoms disappeared after extubation two weeks later. Three cases with postoperative fever cured after anti-infective and symptomatic treatment. Statistical analysis of achievement ratio of ureteral calculi indicated: X2 = 5.231, P = 0.073.Conclusions: The transureteroscopic pneumatic lithotripsy is a safe, fast and effective treatment and is one of the options for the treatment of middle and distal ureteral calculi. Skilled techniques and wealthy of experience are the key points to improve the success rate and to reduce the complications of the surgery. Surgery in this group ureteral stone lithotripsy paragraphs success rate difference was not statistically significant(P>0.05).With the maturity of the skills, the transureteroscopic pneumatic lithotripsy treatment can also be selected for the ureter stones of upper part.