| Objectives To investigate the feasibility and safety of tubeless after flexible ureteroscope holmium laser lithotripsy in the treatment of immediate lithotripsy in upper urinary calculi.Methods The clinical data of 80 patients with upper urinary tract calculi who underwent flexible ureteroscopic holmium laser lithotripsy in the Department of Urology,Tangshan Workers’ Hospital from 2020.02-2021.01 were collected.All the included calculi were unilateral upper ureteral calculi or renal calculi with diameters<2.5cm,mild hydronephrosis;No ureteral malformation,stricture,tumor and severe polyp were found.Before lithotripsy,double J tubes were passively dilated for 2-4 weeks under ureteroscopy.Immediate lithotripsy was performed during flexible ureteroscopic holmium laser lithotripsy.The patients were divided into two groups according to whether they had indwelling double J tubes after operation.Among them,40 patients had indwelling F6 ureteral tubes,and they were named as tubeless group.Forty cases of F6 double J tubes were indwelling and named as tube setting group.F6 ureteral catheter was indwelling for48 h and double J catheter was indwelling for 4 weeks.The average age of the tuberless group was(50.23±12.29)years;There were 28 males and 12 females;Average BMI(24.55±1.94)kg/m2;There were 3 patients with diabetes and 2 patients with hypertension;There were 24 cases of renal calculi,10 cases of upper ureteral calculi and 6 cases of ureteral complicated renal calculi;There were 25 cases of single calculi and 15 cases of multiple calculi;The maximum diameter or accumulated maximum diameter of calculi was 1.1(1-2)cm;The maximum diameter of hydronephrosis was 1.5(1-2)cm;The average CT value was(799.85±260.92)Hu;The mean preoperative urine leukocyte was41.5(32-62)μL.The mean age of the catheter group was(49.73±9.20)years old;There were 23 males and 17 females;The mean BMI was(25.13±1.92)kg/m2;There were 6patients with diabetes and 5 patients with hypertension;There were 16 cases of renal calculi,18 cases of upper ureteral calculi and 6 cases of ureteral complicated renal calculi;Among them,30 cases had single calculi and 10 cases had multiple calculi;The maximum diameter or accumulated maximum diameter of calculi was 1.15(1-1.5)cm;The maximum diameter of hydronephrosis was 1.050(1-2)cm;The average CT value was(760.60±322.05)Hu;The mean preoperative urine leukocyte was 36.5(19.75-68.5)μL.There was no significant difference between the two groups in the basic information and calculus(P>0.05).Results Eighty patients successfully completed the operation.The incidence of gross hematuria in the non-catheterization group(37.5%,17.5%,5%)was significantly lower than that in the catheterization group(62.5%,40%,22.5%),P<0.05;The pain scores(1.28±1.414,1.73±2.309,0.8±1.067)in the non-catheterization group were significantly lower than those in the catheterization group(3.63±2.306,2.6±1.336,1.5±1.061),P<0.05;The incidence of urinary tract irritation in the non-catheterized group(2.5%)was significantly lower than that in the catheterized group(12.5%)on the third day after surgery,P<0.05;The hospitalization cost of the non-catheterization group was 21924 (20777.5-24528)yuan,significantly lower than that of the catheterization group was23645.5(22280-26705.25)yuan,P<0.05;The length of hospitalization in the non-tube group 6(5.25-7)d was significantly shorter than that in the control group 7(6-8)d,P<0.05.There were no significant differences in operation time,blood white blood cells,C-reactive protein,procalcitonin,interleukin-6,serum cortisol,renal function between the two groups,and renal function and hydronephrosis 1 month later,P>0.05.Conclusions For better ureteral conditions(no ureteral malformation,no ureteral stricture,no severe polyps),unilateral,diameter<2.5cm,patients with upper urinary calculi of mild hydronephrosis.If there is no obvious ureteral injury and immediate stone free during the operation of flexible ureteroscopic holmium laser lithotripsy,postoperative tubeless does not increase the risk of infection and renal function damage,it has good feasibility and safety.Figure10;Table12;Reference 80... |
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