Clinical Application Of Flexible Ureteroscope In Upper Ureteral And Renal Calculi

Objective:To investigate the clinical application of flexible ureteroscope in upper ureteral and renal calculi. Methods:Reviewed the date of 89 patients with upper ureteral and renal calculi from 2011 to 2014, all the patients were treated successfully by laser lithotripsy of flexible ureteroscope,58 male patients(65%) and 31 female patients(35%). Upper ureteral calculi was noted in 21 patients(24%),renal pelvis was noted in 25 patients(28%),upper calyx was noted in 13 patients(14%),middle calyx was noted in 15 patients(17%),lower calyx was noted in 15 patients(17%).The mean age was 38.3+ 11.7years(18-69),the mean stone size was 1.5±0.6cm(08-3.0). Use F8/9.8 ureteroscope under direct vision to inspect and expand ipsilateral ureteral.Then a guide wire is inserted into renal collecting system,The soft sheath is placed along the guide wire after removing the ureteroscope,and place flexible ureteroscope. Find the stones and remove guide wire,place U100 laser fiber, regulate the laser power. The stone will gradually crushed,and the large residual stones will remove with stone basket. A ureteral stent is placed at the end of the operation.The ureteral stent is removed after one month,and recheck KUB or urinary CT to confirm stone free rate. For maximum diameter≥4mm residual stones were deemed clinically significant residual stones, and to arrange adjuvant therapy or do further follow-up observation. Results:In all the 89 patients,80 patients complete remove the stone or residual stone diameter<4mm after one month, the total stone free rate is 90%(80/89). Upper ureteral’s stone free rate is 95.2%(20/21),renal pelvis and upper middle calyx’s stone free rate is 94.3%(50/53),there is no statistically significant difference between the two groups(χ2=0.024, P=0.878> 0.05). Upper ureteral’s stone free rate is 95.2%(20/21), lower calyx’s stone free rate is 66.7%(10/15), there is statistically significant difference between the two groups(χ2=5.143, P=0.023< 0.05). Renal pelvis and upper middle calyx’s stone free rate is 94.3%(50/53), lower calyx’s stone free rate is 66.7%(10/15), there is statistically significant difference between the two groups(χ2=6.615, P=0.013<0.05).The stone free rate of stone diameter< 2.0cm is 94.2%(65/69),the stone free rate of stone diameter≥2.0cm,≤3.0cm is 75.0%(15/20), there is statistically significant difference between the two groups(X2=4.435, P=0.037<0.05). Conclusion:Flexible ureteroscope combined U100 laser lithotripsy is a safe, minimally invasive and effective technology with treating upper ureteral and renal calculi.In the treatment of upper ureteral, renal pelvis and upper middle calyx calculi with diameter<2cm,the clinical effect is obvious.