A Randomized Controlled Clinical Trial On Preoperative Ureteral Stent Placement Before Flexible Ureteroscopic Lithotripsy

OBJECTIVE:to compare the efficacy and safety of preoperative Ureteral Stent placement before Flexible Ureteroscopic Lithotripsy.METHODS:From April 2015 to September 2016,a total of 68 patients with unilateral and single renal stone were selected in this study and treated by Flexible Ureteroscopic Lithotripsy in China-Japan Union Hospital of Jilin University urology.All patients were checked by Colour Doppler Ultrasound,CT,CTU,IVP,diagnosed as unilateral and single renal stone(?2cm).They all conformed to the certificate of Flexible Ureteroscopic Lithotripsy and did not have contraindications,history of ureteral surgery,anatomical abnormality,kidney tuberculosis or Kidney tumor.They were randomly divided into two group.There were 31 patients who were not indwelled the ureteral stent and directly procedure Flexible Ureteroscopic Lithotripsy,as group of control group.37 of the other patients were indwelled the ureteral stent in ureter a week before surgery,as group of experimental group.Both groups need to be placed 14 Fr Ureteral Access Sheath(UAS).If there had difficulties,then we would expand the ureter.If we could not put UAS or Flexible Ureteroscopy in the ureter,we would do the second ureteral surgery or use the Percutaneous Nephrolithotomy(PCNL)for surgery.Before surgery,we analyzed and compared the age,sex,stone diameter,stone position.After surgery,we analyzed and compared the success rate of placement of the Ureteral Access Sheath,the stone-free rates in postoperative 3 days and 3 months,operative time,the Intraoperative and postoperative complications and so on.RESULTS:The issue of 68 patients were successfully completed the Flexible Ureteroscopic Lithotripsy and did not appear serious complications like severe ureteral injury(Piercing,breaking,stripping),kidney damage,severe bleeding and Septic shock and so on.Only three patients had the Systemic inflammatory response syndrome(SIRS).We analyzed and compared the age,sex,stone diameter,stone position,found the difference between two group was no statistical difference(P>0.05).Comparing the control group and experimental group,the success rate of placement of the UAS was 21/31(67.74%)and 35/37(94.59%),the operation time was(89.39±11.88)min and(78.22±8.99)min.There were statistical differences between two aspects(P<0.05).Comparing the two group,the stone-free rates in postoperative 3 days was 61.29% and 59.46%,the stone-free rates in postoperative 3 months was 87.10% and 91.89%,the postoperative complications was 6.45% and 2.70%.The above differences were not statistically significant(P>0.05).CONCLUSION:Indwelling the ureteral stent in ureter a week before Flexible Ureteroscopic Lithotripsy,can obviously Improve the success rate of placement of the UAS,reduce the operation time and makes the surgery convenient and effective.