| Objective:To study the efficacy and safety of the integrated flexible and rigid ureterorenoscope(F&R-URS)in the treatment of upper ureter or renal pelvis stones,clinical experience and information for the treatment of related diseases was provided in the mean time.Methods:The clinical data of 48 patients with upper ureter or renal pelvis stones in the Department of Urology of Chenggong Affiliated Hospital of Xiamen University from January 2015 to March 2017 were retrospectively analyzed.The stones were single in Urinary system,with diameter of 1?2cm.Perfected the assessment of stone conditions,preoperative related inspection and preoperative surgical treatment.25 cases Among them were treated with F&R-URS,while 23 cases treated with minimally invasive percutaneous nephrolithotomy(mPCNL)lithotripsy.According to surgical methods,patients are divided into F&R-URS group and mPCNL group.Postoperative,the operative effect and safety of both groups were compared,urolithiasis specimens of patients were treated with infrared spectrophotometry to analysis the urinary composition.The age,gender,location of stone,stone size and stone treatment before were compared between the two groups showed no statistically significant(P>0.05).Results:In the F&R-URS group,the rate of stone found was 96%and 100%in the mPCNL group.Due to the stone falling into the lower kidney and the small infundibulopelvic angle(IPA),a case in the F&R-URS group couldn't find the calculus,so changed with minimally invasive percutaneous nephrdithotomy(mPCNL),this case was not included in statistics analysed.The amount of blood loss of the F&R-URS group was 6.83 ± 2.60ml lower than that of the mPCNL group(75.57 ± 18.85ml),the difference was statistically significant(P<0.05).The comparison of operation time,the F&R-URS group was 59.79 ± 9.93min lower than the control group 126.52±17.56min,compared with the postoperative hospital stay,F&R-URS group 4.25 ±1.36d,lower than the mPCNL group 7.35±2.56d,compared with the treatment costs,The F&R-URS group was 18440.5 ± 1178.39 yuan lower than the mPCNL group 30511.14 ± 1633.73 yuan,these difference were statistically significant(P<0.05)The rate of total stone clearance in F&R-URS group was 91.67%and 95.65%in mPCNL group the comparation between the two groups showed no statistically significant.(P>0.05).The rate of total stone clearance in F&R-URS group was 91.67%and 95.65%in mPCNL group the comparation between the two groups showed no statistically significant..A case in F&R-URS group accepted Assisted extracorporeal shock wave lithotripsy(ESWL)treatment.Clavien-Dindo Classification System(CDCS)was used in the Evaluation of postoperative complications.The main complications of grade I:fever(<38.5 ?),urinary tract infection,postoperative bleeding and grade ?:mildly elevated serum creatinine,blood transfusion.No grade ? and above occurred.The incidence of grade I in the F&R-URS group was 12.5%compared with 21.7%in the mPCNL group(P>0.05).The incidence of grade II complication was 4.16%in the F&R-URS.group and 13.04%in the mPCNL group,P>0.05.23 patients in mPCNL group were analyzed for urinary stone composition,and only 19 patients in the F&R-URS group were collected for stone analysis.The stones were analyzed for urinary composition.The stones with the highest detection rate were calcium oxalate + calcium phosphate stones(45.24%),followed by calcium oxalate stones(38.10%),magnesium ammonium phosphate hexahydrate + calcium oxalate stones(7.14%),uric acid stones%),Calcium phosphate and uric acid + calcium oxalate stones accounted for a lower proportion(both 2.38%).Conclusions:The F&R-URS is safe and effective in the treatment of the upper ureter and renal pelvis stones.With a high rate stone clearance,it can achieve similar clear stone effect to mPCNL.Compared with mPCNL,the F&R-URS is less bleeding,shorter operative time,lower cost of treatment,faster recovery after surgery,less complications,with broad prospects for the use. |
PDF Full Text Request