| Objective: Extracorporeal physical vibration lithecbole(EPVL)is an independently developed active lithecbole method for upper urinary tract stones in China,and is mainly used for direct discharge of small upper urinary tract stones,lithecbole after extracorporeal shock wave lithotripsy(ESWL),and lithecbole of residual stones after upper urinary tract stone surgery.Retrograde intrarenal surgery(RIRS)is currently one of the main methods for the treatment of renal calculi,but it is prone to residual stones after surgery and its stone-free rate is relatively low.This study aims to analyze the factors on the efficacy of EPVL,and thereby explore evidence-based medical means to predict and improve the efficacy of EPVL in patients with post-RIRS renal residual stones.Methods: From January 2020 to December 2022,among the patients hospitalized in the urological department of our hospital and underwent RIRS,106 of them were collected who had residual renal stones and accepted EPVL.The maximum diameter of the fragment stones was determined to be <0.6cm during the operation,and there were indeed significant residual stones under B-ultrasound or CT scans after the operation.All the 106 patients had complete clinical data and met the inclusion and exclusion criteria.The recruited patients were grouped according to gender,height,body mass index,stone orientation(left and right),stone composition,stone location,and stone load respectively to analyze the effective factors on the stone removal of EPVL.In addition,among the 52 patients with residual stone of inferior calyx,28 of them have been designed with a three-dimensional EPVL lithotripsy path from the small calices to the large calices,from the large calices to the renal pelvis,and then from the renal pelvis to the ureter based on the CTU.According to this path,EPVL will be performed in different postures and angles.The other 24 patients were treated with EPVL lithocalculus in the head low and foot high position + healthy lateral decubitus position.And compare the lithocalculus effect of the two groups.Results: There were no significant differences in the stone removal rate within 7days and the stone free rate within 4 weeks after EPVL stone removal among different gender,height,stone location,and stone load groups(all P>0.05);The patient’s body mass index had no significant impact on the stone removal rate within 7 days after EPVL treatment(P=0.449),but had a significant impact on the stone free rate within4 weeks(P=0.009).The stone free rate in patients with a body mass index ≥ 24 was significantly lower than those in patients with a body mass index of 18.5 to 23.9(P=0.002);The stone composition had no significant impact on the stone removal rate within 7 days after EPVL treatment(P=0.277),while the residual stone free rate within 4 weeks in patients with calcium containing primary stones was significantly higher than that in patients without calcium containing primary stones(P=0.001);The stone removal rate within 7 days and the stone free rate within 4 weeks after treatment with EPVL in the upper and middle calyces were significantly higher than those in the lower calyces group(P=0.012,P=0.001);For lower calyceal calculi,there was no significant difference in the 7-day stone removal rate between conventional EPVL stone removal and CTU-based three-dimensional stone removal path design EPVL stone removal(P=0.096),while the 4-week stone free rate of the latter was significantly higher than that of the former(P=0.014);Conclusion: EPVL has a definite effect on the removal of residual stones after RIRS,and high body mass index,non calcium containing stones,and stones located in the lower calyces are independent risk factors that affect the removal of stones;For residual stones in the lower calyces of the kidney,EPVL that according to the threedimensional stone removal path designed based on CTU can significantly improve the stone removal effect. |
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