| Objective: This study aimed to explore the the effectiveness and safety of bilateral same-session ureteroscopy with holmium laser lithotripsy for bilateral upper urinary calculi.Methods: Between January 2014 and October 2017,88 cases of bilateral upper urinary calculi at North Sichuan Medical College Affiliated Hospital were retrospectively analyzed,including 59 males(67.0%)and 29 females(33.0%).aged between 13 and 75 years,with an average age of(49.9±12.6)years.The stone size,number and position were evaluated by B-ultrasound,KUB,CT.The mean stone size was(16.3±4.3)mm(8~28),stone number 2~6,the average(2.4±0.8).7(8%)cases of stone in bilateral kidney,54(61.4%)cases of bilateral ureteral calculi,including 21 cases(38.9%)of upper ureteral,9 cases(16.7%)of lower ureteral,other 24 cases(44.4%).One side of kidney stones and the other side of ureteral stones in 27(30.6%)patients.Whether the ureteral stent was retained before the operation was determined according to the general condition of the patients,the condition of the stones and the needs of the operation,and 22(25.0%)cases were performed preoperatively.All operations were performed under general anesthesia.Ureteral calculi were treated by rigid and(or)flexible ureteroscopy combined with holmium laser lithotripsy.While upper ureteral calculi were drifted to kidney and kidney stones,flexible ureteroscope with holmium laser lithotripsy was performed.Postoperatively,ureteral catheter was retained 24~48 hours and ureteral stent was retained 4 weeks.KUB was reviewed on day 1~3 and 4 weeks after the operation in order to evaluate the residual stone.According to the size of stone is divided into low burden(<20mm)and high burden group(? 20mm).According to the stone position is divided into three group,ueteral group,kidney group,kidney combined ureter group.The operation time,the immediate stone clearance rate,the total stone clearance rate,the incidence of postoperative complications,hospital stay,postoperative hospital stay were compared.Patients were divided into groups according to postoperative complications and perioperative data were compared.Results: The average time of operation was(90.8±34)min,the immediate stone clearance rate was 60.2%(53/88),the total stone clearance rate was 84.1%(74/88).The immediate clearance rate of stones was compared between the low burden group and the high burden group(71.4% vs 32.0%,P<0.05).Ureteral group,kidney group,kidney combined ureter group three group comparison,was statistically significant difference in operation time,the immediate stone clearance rate,the total stone clearance rate(P<0.05).The complication rate was 11.4%(10/88).According to the Clavien-Dindo grading system for assessing postoperative complications,including 7(8%)cases of grade 0-II,1(1.1%)cases of grade III,2(2.3%)above grade III.Conclusion: Bilateral same-session ureteroscopy is safe and effective for the management of bilateral upper urinary tract stones,is one of the methods to treat bilateral upper urinary tract stones at the same time.Especially for the patients with stone burden <20mm,and bilateral ureteral stones,the effect is more satisfactory. |
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