Efficacy And Safety Analysis Of Flexible Ureteroscopic Lithotripsy In The Treatment Of Renal Stones With Chronic Kidney Disease

ObjectiveTo evaluate the efficacy and safety of flexible ureteroscopic in the treatment of renal stones with chronic kidney disease,we analyzed 29 renal stones patients with chronic kidney disease and 33 renal stones patients without chronic kidney disease.MethodsRetrospective analysis the clinical data of 29 kidney stone patients with chronic kidney disease treated with flexible ureteroscopic from June 2013 to June 2016 at the First Affiliated Hospital of Zhengzhou University and 33 kidney stone patients without chronic kidney disease were selected for comparison at the same time.The chronic kidney group consist of 15 IgA nephritic disease,8 hypertensive nephrosclerosis,5 DN Diabetic Nephropathy and 1 systemic lupus erythematosus.The size of the stone is based on the maximum diameter measured by CT.The size and position of the stones were determined by KUB,urinary color Doppler ultrasound and CT examination before operation.Blood routine,liver and kidney function,coagulation function,urine routine,urine culture and electrocardiogram were examined.Elderly patients and patients with cardiopulmonary diseases were tested by by pulmonary function.All surgeries were performed by the same experienced physician.The D-J tube was not routinely retained before surgery and the ureteral transport sheath(UAS)was used to assist the endoscopy.The patients with double renal calculi were first treated easier to clear side,and the contralateral stones were treated one month later.The intraoperative and postoperative data of patients were collected,and the rate of removal of stones and the incidence of surgical complications were compared between the two groups.Certain indexes,operation time and volume of intraoperative blood loss were collected and compared.Postoperative blood creatinine values of patients were recorded and compared with preoperative blood creatinine values.Results1.There was no significant difference between patients of renal stones with chronic kidney disease and renal stones without chronic kidney disease in age,stone size,and kidney stone position.2.In the group of renal stones with chronic kidney disease,33 operations were performed.The success rate of one-time surgery was 93.9%(31/33).In the group of renal stones without chronic kidney disease,36 operations were performed.The success rate of one-time surgery was 94.4%(34/36).4 cases failed to enter the mirror.After 2 weeks of 6F ureteral stent passive dilatation,the reoperation was successfully implanted in UAS.3.The intraoperative blood loss of kidney stone patients with chronic kidney disease and without chronic kidney disease was 9.5 ± 3.6ml and 7.2 ± 3.3ml,respectively.The average operation time was 62.1 ± 7.7min and 56 ± 7.0min,respectively.The intraoperative blood loss and operation time of renal stones patients with chronic kidney disease were significantly higher than those without chronic kidney disease(P < 0.05).The total complication rate of kidney stone patients with chronic kidney disease and without chronic kidney disease was 21.9% and 11.1%(P>0.05),respectively.Postoperative average hospitalization time were 3.24±0.75 d and 3.13±0.59d(P>0.05),respectively.4.The stone clearance rate of first month after operation was 84.8%(28/33)in renal stone with chronic kidney disease group.The clearance rates of renal pelvis,the upper calyx and the lower renal calyx were 92.3%(12/13),90.1%(10/11),and 66.7%(6/9)respectively.The stone clearance rate of first month after operation was 91.6%(33/36)in renal stone without chronic kidney disease group.The clearance rates of renal pelvis,the upper calyx and the lower renal calyx were 100%(12/12),92.3%(12/13)and 81.8%(9/11).There was no significant difference in postoperative stone clearance between the two groups(P>0.05).Five patients with residual stones(maximum diameter 6-8mm)had successful ESWL lithotripsy in eight patients,three patients with small residual stones(<6mm)were treated with oral drugs.5.The average creatinine values(?mol/L)of on the first day before operation and first,third,and first month after operation in kidney stone patients with chronic kidney disease were 286.09±91.86,298.55±92.56,288.06±90.40 and 278.45±89.01,respectively.The average creatinine values(?mol/L)of on the first day before operation and first,third,and first month after operation in kidney stone patients without chronic kidney disease were 56.22±14.17?61.39±15.69?57.22±13.67?54.56±13.95.Compared with preoperative creatinine values,there was no significant change in postoperative blood creatinine level(P>0.05).ConclusionsThe operation time of flexible ureteroscopic in the treatment of renal stones with chronic kidney disease were long.However,the stone clerance rates in the two groups were similar,and there was no significant difference in the incidence of surgical complications.No serious surgical complications occurred during and after operation.The surgery of flexible ureteroscopic had little effect on postoperative renal function.Flexible ureteroscopic is safe and effective and the postoperative recovery is fast for the treatment of patients of renal stones with chronic kidney disease.So,renal stones patients with chronic kidney disease can be treated with flexible ureteroscopic lithotripsy.