Clinical Efficacy Assessment Of Negative Pressure Combined With Ureteroscopy For Upper Urinary Calculi

Background: Urinary calculi occupy the first place among hospitalized patients in Urology.The incidence rate in China is 1% to 5%,and the incidence rate in the southern region is as high as 5% to 10%,of which 25% require hospitalization.In recent years,the incidence of stones has increased year by year,and China has become one of the three regions with high incidence of urinary calculi in the world.At present,minimally invasive treatment of urinary calculi has taken the paramount position.Natural cavity ureteroscopic holmium laser lithotripsy is recommended for the treatment of ?2cm kidney stones or upper ureteral calculi,but ureteroscopic lithotripsy does not have the function of synchronous clear stone,and it is prone to postoperative residual stones when the stone load is large.There is now a new domestic ureteroscope-negative pressure combined ureteroscopy.It is equipped with a negative pressure channel,which can effectively control the intra-renal pressure,thus ensuring the safety of the operation while more efficient clearing stone.This study evaluated the clinical efficacy of negative pressure combined ureteroscopy for upper urinary calculi.Objective: To evaluate the clinical efficacy of negative pressure combined ureteroscopy in the treatment of upper urinary calculi.Methods: A retrospective analysis of 34 patients with negative pressure combined ureteroscopy and 43 patients with rigid ureteroscopy from May 2017 to November 2018 in Second Affiliated Hospital of Dalian Medical University.Among them,30 patients underwent negative pressure combined ureteroscopy for ureteral calculi,and 4 patients underwent negative pressure combined ureteroscopy for the treatment of renal calculi.All operations were performed with general anesthesia and the patient took the lithotomy position.The clinical data of 30 patients with ureteral calculi treated with negative pressure combined with ureteroscopy(observation group)and 43 patients with rigid ureteroscopy(control group)were compared,and the clinical data of 4 patients with negative pressure combined ureteral rigid surgery for the treatment of kidney stones were analyzed separately.Clinical data of patients with negative pressure combined with ureteral hard mirrors,to evaluate the clinical efficacy of negative pressure combined with ureteroscopy in the treatment of upper urinary calculi,and then guide clinical treatment.Results: A total of 30 patients in the observation group,including 20 males and 10 females,with an average age of(56.7±12.5)years.There were 43 patients in the control group,including 26 males and 17 females with an average age of(59.4±14.1)years.There were no significant differences in age,gender and preoperative serum creatinine between the two groups(P>0.05),but there was a statistically significant difference in the average value of the largest diameter of the stone between the two groups(P<0.05).In the observation group,the stone clearance rate was 93.3%(28/30)after 3 days of operation and 1 month after operation.The control group had a stone clearance rate of 90.7%(39/43)3 days after surgery,and the stone removal rate was 93.0%(40/43)at 1 month after surgery.There was no significant difference in the stone clearance rate between the two groups at 3 days and 1 month after surgery(P>0.05).There were no significant differences in the operation time,ureteral mucosal injury rate,postoperative fever rate,and postoperative analgesic use rate between the two groups(P>0.05).Average time of breaking stones of the observation group was shorter than that of the control group,and the difference was statistically significant(P<0.05).The average hospital stay was(2.8±1.5)d and(1.7±1.0)d,respectively.There were significant differences in postoperative hospital stay between the two groups(P<0.05).The average hospitalization fee for the observation group was 17728.9±3128.8?,and the average hospitalization fee for the control group was 21343.3±3346.4 ?.The observation group saved hospitalization costs more than the control group,and the difference was statistically significant(P<0.05).Of the 4 patients with negative pressure combined with ureteroscopy for the treatment of renal calculi,3 had pyelone stones and 1 had incomplete staghorn calculi.Four patients had normal postoperative body temperature.Two patients had residual stones on X-rays 3 days after operation.One month after operation,X-ray showed that only one patient had residual stones,and the residual stone was located in the lower of the right kidney,with a size of about 6 mm.This patient is required to review the patient regularly.Conclusion: 1.Negative pressure combined ureteroscopic holmium laser lithotripsy is superior to ureteral hard holmium laser lithotripsy in operation time;2.Negative pressure combined ureteroscopy saves hospitalization costs compared to ureteral rigid mirrors.3.In the treatment of ureteral calculi,there was no significant difference in the stone clearance rate and postoperative complications between the negative pressure combined ureteroscopy and the rigid ureteroscopy.4.Negative pressure combined ureteroscopy for upper urinary calculi is a feasible,safe and effective surgical procedure.