Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years)

Wang, Keyi; Wang, Guangchun; Shi, Heng; Zhang, Haimin; Huang, Jianhua; Geng, Jiang; Yin, Lei; Huang, Tianrun

doi:10.1007/s11255-019-02252-9

“…The reason may be that this study was well prepared before operation. The patients who were not suitable for ureteroscopic lithotripsy were excluded through the examination of imaging scientists in time [ 24 ]. The postoperative hospital stay can reflect the severity of postoperative complications to some extent.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Yang¹,

Huang

²

,

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. A case-control study was conducted to compare the efficacy and prognostic factors of flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) when treating complex upper urinary tract renal calculi based on a retrospective cohort study. Methods. The study period was from October 2019 to December 2021. A retrospective study was carried out on 100 patients with complicated upper urinary tract nephrolithiasis who underwent surgery in the Urology Department of our hospital. They were assigned into two groups: FURL and PCNL groups. The intraoperative blood loss, operation time, hematuria duration, hospital stay, primary stone removal rate, incidence of intraoperative and postoperative complications, VAS score, level of inflammatory factors, and micturition function were compared. According to the postoperative prognosis, the patients were reassigned into two groups: good prognosis group ( n = 38 ) and poor prognosis group ( n = 106 ). The factors related to poor prognosis after FURL and PCNL were screened, and multivariate loglistic regression analysis was adopted to determine the risk factors. Results. The primary stone clearance rate in the PCNL group was significantly higher than that in the FURL group, and there was no significant difference in the incidence of intraoperative and postoperative complications between the two groups ( P > 0.05 ). The intraoperative blood loss and the duration of hematuria in the PCNL group were significantly shorter than those in the FURL group, and the operation time and postoperative hospital stay in the FURL group were longer than those in the FURL group. The postoperative VAS score in the study group was significantly lower than that in the control group ( P < 0.05 ). The levels of CRP, IL-1, TNF-α, and NF-κB in both groups decreased after operation, and the level of inflammatory factors in the PCNL group was significantly lower than that in the FURL group ( P < 0.05 ). The indexes of IPSS and Q max in the PCNL group were significantly lower than those in the control group 3 months after operation. The index of micturition function in the PCNL group was significantly lower than that in the FURL group. Preoperative use of immunosuppressant, preoperative stone fever, positive preoperative urine culture, preoperative urinary leukocyte count ≥ 544 × L , intraoperative urinary opacity, and pus fur were significantly correlated with poor prognosis of ureteral patients ( P < 0.05 ). Preoperative stone fever, high preoperative urinary leukocyte count, intraoperative urinary turbidity, and suppurative fur were independent risk factors for postoperative SIRS in patients with ureteral calculi. Conclusion. PCNL is effective when treating complex upper urinary tract renal calculi. Compared with FURL, PCNL can remarkably reduce intraoperative blood loss and hematuria duration, can enhance micturition function, and will not remarkably increase the incidence of intraoperative and postoperative complications, high safety. High white blood cell count in urine before operation, fever due to stone before operation, turbid urine, and purulent fur during operation are independent risk factors for postoperative adverse outcome in patients with complex upper urinary tract renal calculi. Patients should be fully treated before surgery.

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“…Mini-PCNL can remarkably reduce bleeding, so it can be promoted and widely used all over the world [ 29 ]. Wu et al reported that the Doppler ultrasound and Doppler ultrasound-guided PCNL can effectively reduce renal vascular injury and reduce the risk of bleeding and the probability of blood transfusion [ 30 ]. According to the results of this study, we believe that the preoperative location of CTU, the selection of the best target calyx and puncture path, combined with the intraoperative Doppler ultrasound real-time guidance puncture can further reduce the risk of renal parenchyma injury and bleeding.…”

Section: Discussionmentioning

confidence: 99%

Application of CTU-Assisted Doppler Ultrasound Puncture in Nontube Percutaneous Nephrolithotomy, Its Effect on Patients’ Complications, and Its Clinical Value

Xu

¹

,

Liu

²

,

Jia

³

et al. 2022

BioMed Research International

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Objective. To research the application of CTU-assisted Doppler ultrasound puncture in uncatheterized PCNL, its influence on patients’ complications, and its clinical value in a case-control study. Methods. One hundred and forty-four patients who went through percutaneous nephrolithotomy (PCNL) from March 2019 to June 2021 in our hospital were arbitrarily assigned into the CTU group ( n = 72 ) and CT plain scan group ( n = 72 ). CTA+CTU was adopted to determine the puncture passage in the CTU group, and CT scan was employed in the CT group. The intraoperative blood loss, postoperative blood loss, operation time, hospital stay, primary stone removal rate, and the incidence of intraoperative and postoperative complications were compared. The visual analogue score (VAS) was employed to assess the degree of postoperative wound pain. Results. The first-stage stone removal rate in the CTU group was 95.83% (69/72), which was remarkably higher compared to the CT plain scan group, which was 81.94% (59/72), and the difference was statistically significant ( P < 0.05 ). The overall rates of intraoperative complications were 6.94% (5/72) in the CTU group and 18.06% (13/72) in the CT plain scan group, respectively, which exhibited great differences ( P < 0.05 ). In addition, the overall rates of intraoperative complications were 2.78% (2/72) in the CTU and 13.89% (10/72) in the CT plain scan group, respectively, and the difference was statistically significant ( P < 0.05 ). The operation time and postoperative hospital stays in the CTU group were remarkably shorter compared to the CT group, and the difference was statistically significant ( P < 0.05 ). The intraoperative and postoperative blood loss of CTU group displayed obvious less than that of the CT group, and the difference was statistically significant ( P < 0.05 ). The VAS were compared 24 hours after surgery. After operation, the VAS of 24 hours after operation in the CTU group ( 0.92 ± 0.12 ) were remarkably lower compared to the CT group ( 1.22 ± 0.15 ), and the difference was statistically significant ( P < 0.05 ). Discussion. PCNL is constantly being optimized by CTU-assisted Doppler ultrasound puncture to improve stone clearance rates, reduce postoperative bleeding, be less painful, provide rapid recovery, and provide safe and feasible results. It is therefore worthwhile to standardize and then widely promote it in clinical practice.

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“…For incarcerated upper ureteral calculi larger than 12 mm, stone clearance of RLU was better than that of semirigid URS [28]. Indeed, RLU offers many advantages [29], but it is necessary to choose the method of surgery according to the actual situation to improve the treatment effect and ensure safety [30].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transperitoneal and Retroperitoneal Laparoscopic Ureterolithotomy: A Meta-Analysis

Huang¹,

Yang²,

Shao³

et al. 2022

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Purpose: The aim of this study was to evaluate the efficacy and safety of transperitoneal and retroperitoneal laparoscopic ureterolithotomy (TLU and RLU). Materials and Methods: We undertook a literature search PubMed, Embase, and the Cochrane Library. Search date will range from inception to January 1, 2020. The final article results will be analyzed using StataSE 12 software. This meta-analysis was reported according to PRISMA guidelines, and a protocol was registered in PROSPERO (CRD42020160906). Results: Eleven articles eventually met the requirements, involving a total of 609 patients. The final result shows the operative time (Std. Mean Difference [SMD] = 0.58; 95% CI 0.36–0.80; p < 0.01), hospital stay (SMD = 0.26; 95% CI 0.02–0.49; p = 0.031), and the complication of paralytic ileus (risk difference = 0.11; 95% CI 0.05–0.17; p < 0.01) are significant difference between TLU and RLU, and TLU are higher or longer. Conclusions: Our meta-analysis suggests that if there are no other constraints, it is better to choose RLU. And more clinical trial data are needed to confirm this conclusion.

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Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years)

Cited by 12 publications

References 29 publications

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Application of CTU-Assisted Doppler Ultrasound Puncture in Nontube Percutaneous Nephrolithotomy, Its Effect on Patients’ Complications, and Its Clinical Value

Comparison of Transperitoneal and Retroperitoneal Laparoscopic Ureterolithotomy: A Meta-Analysis

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