| Objective:This research was developed to compare the clinical efficacy of disposable flexible ureteroscope and reusable flexible ureteroscope in the treatment of upper urinary tract stones.Methods:A total of 181 patients with upper urinary tract calculi who were treated in the urology department of our hospital from January 2020 to December 2020 were retrospectively collected.They were divided into two groups according to the use of flexible ureteroscope.Among them,102 patients in the control group received reusable flexible ureteroscope to treat upper urinary tract calculi;79 cases in the observation group were treated with disposable flexible ureteroscope for upper urinary tract calculi.There was no statistical difference in the comparison of general data between the two groups of patients,and they were comparable.One month after the operation,Imaging examinations were performed to evaluate the residual calculus and decide whether the ureteral stent was removed.The general data of patients were collected,including age,sex,stone size,stone location,side of stone,hydronephrosis,hospital stay,etc.The preoperative and postoperative serum creatinine(SCR),hemoglobin(Hb)concentration,white blood cell(WBC)count,antibiotic use,total hospital stay,postoperative hospital stay,hospital costs and stone composition of patients in both groups were recorded and analyzed.Results:1.The two groups of hydronephrosis were statistically analyzed,in the control group,16 cases(15.69%)had no hydronephrosis,83 cases(81.37%)had mild hydronephrosis,3 cases(2.94%)had moderate hydronephrosis,in the observation group,10 cases(12.66%)had no hydronephrosis,24 cases(30.38%)had mild hydronephrosis,45 cases(56.96%)of moderate hydronephrosis.The two groups of stone positions were statistically analyzed,in the control group,42 patients(41.18%)were located on the right side and 60 patients(58.82%)were located on the left side;in the observation group,39 patients(49.37%)were located on the right side and40 patients(52.63%)were located on the left side.2.The results of comparing the operation time of the two groups showed that the mean operation time of the control group was 1.08±0.40 h,and the mean operation time of the observation group was 1.20±0.40 h.The operation time of theobservation group was significantly longer than that of the control group(P<0.05).Postoperative follow-up results showed that there were 70 cases of stone removal in the control group,accounting for 68.63%.In the observation group,65 cases were removed completely,accounting for 82.28%.The results showed that the stone free rate of disposable flexible ureteroscope was significantly better than reusable flexible ureteroscope(P<0.05).3.In the control group,the preoperative mean value of creatinine was 88.25±31.23μmol/L,the postoperative mean value of creatinine was 87.34±28.18μmol/L,the preoperative mean value of white blood cell was 7.13±1.97(×10~9),the postoperative mean value of white blood cell was 8.17±2.34(×10~9);the preoperative mean value of hemoglobin was 136.31±16.97g/L,and the postoperative mean value of hemoglobin was 128.16±16.54g/L.In the observation group,the preoperative mean value of creatinine was 88.89±33.56μmol/L,the postoperative mean value of creatinine was87.66±27.47μmol/L,the preoperative mean value of white blood cell was6.98±1.52(×10~9),the postoperative mean value of white blood cell was8.89±2.24(×10~9),the preoperative mean value of hemoglobin was 137.78±17.14g/L,and the postoperative mean value of hemoglobin was 135.44±16.39g/L.The changes of creatinine was no significant difference between the two groups(P>0.05).There was a difference between the two groups in white blood cell and hemoglobin(P<0.05).The increase of white blood cell in the observation group was higher than that in the control group;the decrease of hemoglobin in the observation group was lower than that in the control group.4.In the control group,there were 27 patients(26.47%)with stents before operation and 75 patients(73.53%)without stents;in the observation group,19 patients(24.05%)with stents before operation,and 60 patients(75.95%)without stents.In the control group,the maximum stone superficial area was 4cm~2,and the average stone maximum diameter was(1.06±0.40)cm,the average stone superficial area was(0.72±0.47)cm~2;in the observation group,the maximum stone area was 4.42cm~2,and the average stone maximun diameter was(1.21±0.59)cm,the average stone superficial area was(0.91±0.79)cm~2;there was difference between the two groups(P<0.05).5.In the control group,there were 5 patients(4.90%)who did not use antibiotics after operation.The average number of days of antibiotic use was 2.86±2.53 days,the average total hospitalization days was 8.03±5.46 days,and the postoperative hospitalization was 2.73±1.62 days.There were no intraoperative complications,and the cost was 24013.36±6596.02 yuan.In the observation group,there were 4 patients(5.06%)who did not use antibiotics after operation.The average number of days of antibiotic use was 2.12±1.79 days,the average total hospitalization days was7.29±4.79 days,and the postoperative hospitalization was 2.41±1.81 days.There were no intraoperative complications,and the cost was 30171.91±7165.84 yuan.The days of antibiotic use after operation of control group was significantly higher than that of the observation group.The cost of the observation group was significantly higher than that of the control group(P<0.05).6.In the control group,32 patients(31.37%)who had residual stones after operation.Three patients had complications of fever,the hightest temperature was 38℃.In the observation group,there were 14 cases(17.72%)who had residual stones after operation,and 2 patients had complications,one with postoperative fever of 38.3°C,7one with postoperative bleeding,and nephrostomy was performed after renal pelvis obstruction.7.The analysis of stone composition showed that in the control group,there were 69cases(67.65%)of calcium oxalate monohydrate and calcium oxalate dihydrate,10cases(9.80%)of carbonate apatite,and 14 cases(13.73%)of calcium oxalate monohydrate and carbonate apatite,anhydrous uric acid in 3 cases(2.94%).In the observation group,there were 42 cases(53.16%)of calcium oxalate monohydrate and calcium oxalate dihydrate,15 cases(18.99%)of calcium oxalate monohydrate and calcium oxalate dihydrate with carbonated apatite,and 9 cases of calcium oxalate monohydrate and carbonated apatite.(11.39%),anhydrous uric acid in 2 case(2.53%).Conclusion:1.Disposable flexible ureteroscope was safe and effective in the treatment of upper urinary tract stones.2.Compared with the reusable flexible ureteroscope,the disposable flexible ureteroscope improve the stone free rate,reduce the risk of bleeding,and shorten the use time of antibiotics after operation.3.Both disposable flexible ureteroscopes and reusable flexible ureteroscopes had certain curative effects on the upper urinary tract stones,but considering the hygiene and convenience,maintenance costs,stone free rate,the use of disposable flexible ureteroscope is still recommended. |
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