Analysis Of The Efficacy Of Ureteroscopy Combined With Negative Pressure Suction Work Sheath In The Treatment Of Patients With Renal Calculi Under Different Degrees Of Hydronephrosis

Objective:To investigate the effectiveness and safety of ureteroscopic soft holmium laser lithotripsy combined with negative pressure suction work sheath in the treatment of renal stones under conditions of different degrees of hydronephrosis.Methods:The clinical data of 159 patients with renal stones treated with ureteroscopic flexible lithotripsy combined with negative pressure suction work sheath at the First Hospital of Shanxi Medical University from August 2019 to October 2022 were retrospectively analyzed.The data were divided into four groups according to the severity of hydronephrosis,and the data collected included age,gender,comorbidities,stone characteristics(affected side,size,number,CT value,etc.),operation time,hospital stay,stone removal rate(SFR),and perioperative complication rate,with the main index being postoperative SFR and the secondary indexes being operation time and perioperative surgical complication rate,to compare different degrees of hydronephrosis The differences in preoperative and postoperative data between the patients were compared.All four groups of patients completed the surgery successfully.159 patients had a negative pressure suction sheath successfully placed in stage I(11 patients were not included in the group because they were not successfully sheathed intraoperatively and underwent percutaneous nephrolithotomy for lithotripsy).19 of these patients had intraoperative balloon dilatation of the stenotic segment.16 patients had a retrograde double J tube placed on the affected side under local anesthesia 1-2 weeks before surgery.Reaslt:All four groups of patients completed the procedure successfully.The duration of surgery was significantly longer in the moderate and severe hydrocele groups than in the no and mild hydrocele groups [(64.87±10.59,69.89±11.93)min compared with(52.54±8.25,53.50±9.21)min](p=0.001).The rate of stone removal 1 day and 1 month after surgery was significantly lower in the group with severe effusion compared to the group without effusion.[15/25(60.0%),16/25(64.0%)compared to 64/70(92.4%),66/70(94.3%)],with statistically significant differences between groups(P=0.002),(P=0.001).The rate of intraoperative lithotomy basket use was significantly higher in the severe effusion rent compared to the remaining three groups [21.4%(15/70)compared to 23.5%(8/34),53.3%(16/30),88%(22/25)],with a statistically significant difference between the groups(P=0.001).There were 22 cases of postoperative fever,11 cases of mild ureteral injury,and 3 cases of severe infection with infectious shock,all of which were cured by nephrostomy to relieve obstruction,improve drainage and anti-infection treatment.2patients developed ureteral stone street and were treated by second-stage surgery.No complications such as bleeding,avulsion,or perforation occurred.There was no statistically significant difference in the length of stay and complication rate between the four groups(P>0.05).Conclusion:Ureteroscopy combined with negative pressure suction sheaths is safe and effective in treating mild to moderate hydronephrosis combined with renal stones,and the surgical results are less effective in the case of severe hydronephrosis.