The Efficacy Analysis Of Flexible Ureteroscopy Combined With High-power Holmium Laser In The Treatment Of Kidney Stones Larger Than 2 Cm

Background Objective:Urinary stones are the most common disease in hospitalized patients in urology.About 12%of the global population is affected by it,and it is increasing year by year.The prevalence of urinary stones in adults in China is about 6.5%.The prevalence of male patients,rural patients,and southern patients is relatively high.The recurrence rate of urinary stones is extremely high,and the recurrence rate at 5 years can reach 50%.At present,the clinical treatment of urinary calculi has become minimally invasive,such as extracorporeal shock wave lithotripsy,ureteroscopy lithotripsy,retrograde intrarenal surgery,percutaneous nephrolithotomy lithotripsy,and other minimally invasive surgical methods.At present,for kidney stones larger than 2cm,domestic and foreign guidelines recommend PCNL as the preferred treatment.Retrograde intrarenal surgery can be used to treat kidney stones<2 cm and has been recommended as a first-line treatment for the guidelines.For flexible ureteroscopy treatment of stones above 2 cm,there is controversy,because ordinary holmium laser fiber has low load energy,low power,low stone crushing efficiency,long operation time,and high risk of postoperative complications.However,experienced operative urologists have tried to treat stones above 2cm and achieved good results.In 2016,the consensus of Chinese experts on ureteroscopy has pointed out that for kidney stones>2 cm,flexible ureteroscopy can be used as an alternative treatment.The new generation of high-power holmium laser has greatly improved in laser energy and fiber performance.Its optical fiber can withstand higher energy,achieve high-power lithotripsy,improve lithotripsy efficiency,shorten surgery time,and reduce surgical risk.Therefore,the high-power holmium laser provides feasibility for the treatment of kidney stones of 2?3cm or even more than 3cm.Objective:Explore to clinical efficacy of flexible ureteroscopy combined with high-power holmium laser for kidney stones?2cm.Methods:Retrospective analysis of clinical data of patients undergoing flexible ureteroscopy combined with high-power holmium laser in the urology department of the Second Affiliated Hospital of Zhengzhou University from January 2019 to December 2019 in the treatment of renal stones with a size of?2cm,and collected statistics on gender,age,stone characteristics normal information;outcome data including calculus clearance rate,postoperative high fever,postoperative stone street formation,urinary sepsis,and stone composition analysis were recorded and analyzed at 4 weeks after the operation.SPSS 20.0 statistical software was used for statistical analysis of the measurement data,expressed as mean ± standard deviation(x ± S),and the results were retained to 2 decimal places.Results:A total of 99 patients were selected.There were 69 males and 30 females;aged 16 to 70 years,with an average of(48.45 ± 13.45)years;85 cases of single stones,including 37 cases of renal pelvis stones,13 cases of adrenal calyx stones,10 cases of middle calyx stones,and kidney 25 cases of lower calyx stones;14 cases of multiple kidney stones;the largest diameter of stones is 20-39mm,with an average of(25.94±5.03)mm;of which 78 cases are 2?3cm stones and 21 cases are?3cm stones;CT value of stones is 769?1960 Hu,Average(1261.26±262.08)Hu;operation time 30?110 min,average(72.02±25.78)min;postoperative hospital stay 2?7 d,average(4.46±2.31)d.The postoperative stone removal rate was 84.84%(84/99),of which the stone removal rate in the 2 to 3 cm group was 88.46%(69/78),and the stone removal rate in the?3 cm group was 71.43%(15/21).The total complication rate was 4.04%(4/99);the complication rate in the 2 to 3 cm group was 3.85%(3/78),including one case of ureteral stone street after operation,which was successfully treated with secondary hard mirror surgery;2 cases of postoperative high fever,improved after giving physical cooling and anti-infection treatment;the incidence of complications in the ?3cm group was 4.76%(1/21),including 1 case of urogenic sepsis,after anti-infective shock treatment After being discharged from the hospital,the composition of stones after operation was analyzed as calcium oxalate monohydrate and carbonate apatite;no serious bleeding or organ damage occurred in both groups.Analysis of postoperative stone composition of all patients showed:calcium oxalate stones(calcium oxalate monohydrate,calcium oxalate dihydrate)89 cases,accounting for 90.90%;apatite carbonate and ammonium magnesium phosphate stones totaled 8 cases,accounting for 8.08%;uric acid stones 2 cases,accounting for 2.02%.Conclusions:1.Flexible ureteroscopy combined with high-power holmium laser treatment of kidney stones ? 2cm is a feasible,safe and efficient minimally invasive surgical method,and it is safer and more effective for 2?3cm stones;2.Flexible ureteroscopy combined with high-power holmium laser lithotripsy has fast efficiency,short operation time and fewer postoperative complications;3.Control the renal pelvis pressure during retrograde intrarenal surger to prevent severe postoperative infection;its powdered lithotripsy is conducive to row stone.