Application Of Posture In Transurethral Ureteroscopic Lithotripsy

Objective Ureteroscopy is currently the main method for the treatment of ureteral calculi,which has the characteristics of safety,minimally invasive and effective.However,there are some disadvantages that stones tend to move up and other auxiliary treatment methods need to be added.This study explores the effectiveness and safety of using the position to reduce the upward movement of stones during surgery..Methods First of all,an extracorporeal ureteral lithotripsy device is designed to simulate the movement of ureteroscopic holmium laser lithotripsy at different tilt angles and select the best tilt angle.Included in the cases of ureteroscopic lithotripsy performed in our department from October 2016 to October 2018,The patients who underwent URL with the best tilt angle as the study group(group A)and the patients with URL who underwent conventional lithotomy at the same time as the control group(group B).The basic clinical characteristics,perioperative data,success rate of operation and clinical prognosis of the two groups were compared.According to different types of data,Chi-square test,Fisher accurate test or Student's t test were used to analyze the data.The influence of related factors on stone displacement was evaluated by binary Logistic regression analysis.Results According to the results of in vitro simulated ureteroscopic lithotripsy,the tilt angles of 0 °,20 °,25 °and 30 °were used to move upward in varying degrees when URL was performed.With the increase of tilt angle,the upward movement decreased,and when the angle increased to 25 °and 30 °,the lithotripsy moved up slightly.But at the same time,under the action of gravity,the stone can automatically move down to the tip of the ureteroscope.Under comprehensive consideration,25 °is selected as the improved posture of this study.Among the patients who underwent URL in our department from October 2016 to October 2018,85 cases(group A)were treated with modified 25° anti-Trundrunberg position,and 97.6% of the patients with stones were completely crushed.2.4% of the patients with stones were not completely crushed and moved up to the renal pelvis.In the same period,a total of 80 patients were treated with conventional lithotomy,82.5% of the patients were completely crushed,and 17.5% of the patients needed additional auxiliary lithotripsy.At the same time,the average operation time of the two groups was analyzed.Group A(27.26±10.41min)and group B(39.65±16.11min),P<0.001,the two groups had statistical difference.Further stepwise regression analysis showed that the stone located in the upper segment was the influencing factor of lithotripsy failure,but the size of the stone was not related to the movement of the stone.Conclusion The modified anti-Trundrunberg position can obviously improve the success rate of stone comminution when underwent URL,shorten the operation time,reduce the risk of stone moving up to the renal pelvis and calyceal,reduce the utilization rate of occluder and flexible ureteroscope,and improve the safety of operation.It has certain clinical value to reduce the economic burden of patients.