Clinical Efficacy Of A Combined Pneumatic And Ultrasound Lithotripsy During Percutaneous Nephrolithotomy To Treatment Complex Renal Calculi

Objective to evaluation the efficacy of treatment complex renal calculi by percutaneous nephrolithotomy under B ultrasound~guided;Methods From August 2009 ~ October 2010 ,207 cases of complex renal calculi were treated, 112 cases of male and female 95 cases; age from 14 to 72 years, mean 43.8 years; left 124 cases, 73 cases of right side, bilateral 10 Cases. Staghorn calculi 48 cases, multiple stones in 106 cases, 12 cases of renal dysfunction, 25 cases urinary tract infection, 6 cases of sponge kidney, solitary kidney 2 cases, with diabetes, coronary heart disease in 8 cases. To treated complex renal calculi by percutaneous nephrolithotomy under B ultrasound~guided;Results The percutaneous renal accesswas successfully established underB~type ultrasound guidance in all patients,of which 12 patients with stageⅠset up two of percutaneous renal access, and 2 cases of stageⅠpercutaneous create 3 channels.immediate phaseⅠlithotripsywas performed in 203 cases and delayed phaseⅡlithotripsy in 8 cases ,stone clearance rate of 93.54%. 6 patients were stone diameter less than 1 cm, 1 month later extracorporeal shock wave lithotripsy (ESWL) treatment, 3 patients with minimal residual calculus to be ranked stone therapy. 16 patients after high fever (temperature> 39℃), 23 cases were low~grade fever (temperature> 37.5℃), 6 cases of blood culture positive, 2 cases of pleural injury, the week closed thoracic drainage retention cured, 3 patients bleeding, 2 cases in which super~selective renal artery embolization, all patients were followed up for 3 to 26 months, no stone recurrence.Conclusions The combined pneumatic and ultrasonic device appears to be efficacious and safe for complex renal calculi. Objective To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of intraoperative microbiologic and PCT evaluation in managing postoperative infectious complications.Method: Sixty~eight consecutive patients who had undergone PCNL between january 2010 and October 2010 were prospectively recruited into the study. Preoperative urine cultures positive and PCT detection and intraoperative pelvic urine cultures were obtained from all patients.RESULTS: Of 68 patients, 8 (11.7%) had at least one body temperature recorded at 39 degrees. Fever was associated with a systemic inflammatory response syndrome in one patient (1.6%); 68 cases midstream urine culture positive and Most bacteria were Escherichia coli and Enterococcus feces; 47 cases pelvic urine culture positive and Most bacteria were Escherichia coli ; There were statistically significantly more positive pelvic urine culture than midstream urine culture . 12 cases PCT detection normal, 36 cases >0.5ng/ml; 16cases >2 ng/ml ;4 cases >10 ng/ml.CONCLUSIONS: The results of this study suggest that pelvic urine C&S ( culture and sensitivity testing )are better predictors of potential urosepsis than bladder urine. Therefore, routine collection of these specimens is recommended. Meanwhile,give a reason to use antibiotics .