Simultaneous Treatment Of Ureteropelvic Junction Obstruction With Renal Stones With Laparoscopic Pyeloplasty Combined With Ureteroscopy

Objective:Ureteropelvic junction obstruction is a kind of congenital urinary system disease,and about 1/5 will be accompanied by kidney stones.With the development and application of minimally invasive equipment,it is worth discussing the problem that using minimally invasive techniques in one operation as much as possible to tackle the ureteropelvic junction obstruction with renal stones.In this study,by retrospectively analyzing the clinical data of patients with ureteropelvic junction obstruction complicated with renal calculi,we explored the clinical effect of simultaneous treatment of ureteropelvic junction obstruction with renal stones with laparoscopic pyeloplasty combined with ureteroscopy.Methods:Retrospectively analyzed the clinical data of 18 patients(20 sides)with ureteropelvic junction obstruction with renal stones,who were treated from the urology department of Shandong Provincial Hospital from August 2015 to December 2019.All patients underwent laparoscopic pyeloplasty combined with ureteroscopy.All data including preoperative examinations,surgical preparation,surgical methods,postoperative complications,postoperative review results,were analyzed by using statistical software.Results:1.Of the total 18 patients ureteropelvic junction obstruction with renal stones,there were 14 males and 4 females,with the age of 17 to 68 years(mean age 37.8 years).16 patients had unilateral stones(9 cases on the left,7 cases on the right)while 2 cases had lateral stones.Maximum stone diameter ranged from 3 to 23 mm and an average of preoperative renal pelvis separation was 38.7 mm(range 14-65 mm).18 patients(20 sides)had no conversion to open surgery,no kidney loss,and no perioperative death.2.The total operation time of 18 patients(20 sides)was 100-360 minutes,and the mean operation time was 226.8 minutes.Among them,the stone removal time was 20-150 minutes,the mean time was 71.8 minutes,and the mean bleeding loss was 44 mL.The postoperative hospital stays ranged from 6 to 22 days,with an average of 11.8 days.The stage I stone removal rate was 75%(15/20).Five cases of residual stones were multiple stones,and the remaining stones were all located in the lower kidney.Surgical removal of residual stones was performed in 5 cases,including 3 cases using ureteroscopy and 2 cases using percutaneous nephrolithotomy.Postoperative urine leakage occurred in 2 patients(10%),which was the main complication during the perioperative period.The double J tube was removed 6 to 8 weeks after operation,and the follow-up time ranged from 3 to 36 months,with a mean follow-up of 20.2 months.The degree of renal pelvis separation detested by B-ultrasound was significantly reduced compared with that before the operation.There were no cases of stone recurrence during follow-up.Conclusions:Laparoscopic pyeloplasty combined with ureteroscopy for the treatment of ureteropelvic junction obstruction with renal stones is safe and efficient,with few complications and high stone removal rate.It can resolve UPJO with renal stones simultaneously.However,during the operation,the stone removal process will significantly increase the operation time.Repeated procedure of stone removal will cause edema of the renal pelvis and make it difficult for anastomosis.The main purpose of this operation is to treat the cause of secondary renal stones—ureteropelvic junction obstruction and reduce the load of stones.It reveals practical clinical values for patients ureteropelvic junction obstruction with renal stones.