Objective To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy (ESWL). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2010), MEDLINE (OVID 1950 to April 2010), EMbase (1979 to April 2010), CBM (1978 to April 2010), CNKI (1979 to April 2010), and VIP (1989 to April 2010), and manually searched journals as well. All the randomized controlled trials (RCTs) of treating ureteral stone with ESWL after stent placement were included. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Three RCTs with C-level evidence involving 319 ureteral stone patients were identified. The results of meta-analyses showed that: a) Effect of treatment: The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate (WMD= 1.10, 95%CI 0.87 to 1.38), the quantity of lithotripsy (WMD= 0.43, 95%CI –?1.05 to 0.19), the frequency of shock wave (WMD= 0.00, 95%CI –?0.25 to 0.25), and the power of shock wave (WMD= 0.20, 95%CI –?0.05 to 0.46); and b) Postoperative complications: The ureteral stent placement were prone to cause dysuria (RR= 2.30, 95%CI 1.62 to 3.26), microscopic hematuria (RR= 2.66, 95%CI 1.97 to 3.58), gross hematuria (RR= 6.50, 95%CI 1.50 to 28.15), pyuria (RR= 1.78, 95%CI 1.44 to 2.21), positive urine culture (RR= 2.13, 95%CI 1.71 to 2.64), and suprapubic pain (RR= 3.10, 95%CI 1.59 to 6.04). Conclusions Ureteral stent placement before ESWL is inadvisable. Multi-factors which lead to bias affected the authenticity of our review, such as low-quality and small amount of RCTs. Further large-scale trials are required.
Objective It is a thorny problem to reconstruct long ureteral defect in urinary surgery. To investigate the feasibil ity of intestinal sero-muscular segment with autograft of bladder mucosa as a replacement material for reconstructionof long ureteral defect. Methods Twelve adult Beagle dogs (weighing 6.5-9.3 kg and being male or female) were randomlydivided into 3 groups, each group including 4 dogs. In group A, lower segment of ureter was reconstructed by autograft of bladder mucosa to the intestinal sero-muscular segment; furthermore, the proximal and distal reconstructed ureter were anastomosed to the bladder and the upper ureter, respectively. In group B, upper segment of ureter was reconstructed by the same method as that of group A, the proximal and distal reconstructed ureter anastomosised with pelvic and lower ureter, respectively. In group C, whole ureter was reconstructed by the same method as that of group A, the proximal and distal reconstructed ureter were anastomosised with pelvic and bladder, respectively. Blood urea nitrogen, Cr2+, K+, Na+, Cl-, Ca2+ and carbon dioxide combining power were detected before operation, the general state, drainage volume, heal ing of wound, and compl ications were observed after operation. At 6 weeks, the blood biochemical indexes and intravenous urography (IVU) were detected, and the gross and histological observations of ureter were done. Results In group B, urine leakeage and infection occurred in 1 dog 2 days after operation because ureter stent prolapsed; other dogs had no complications. There was no significant difference in the biochemical indexes between before operation and 6 weeks after operation. IVU showed: in group A, hydronepherosis and ureterectasia occurred on the operation side of 1 dog; in group B, anastomotic stricture between the reconstructed ureter and lower ureter and hydronepherosis occurred in 1 dog; and in other dogs of all groups, renal function was good and the reconstructed ureter had peristalsis function. The histopathological observation showed that the reconstructed ureter had similar structure to normal ureterat 6 weeks in 3 groups; the inflammatory cells infiltrating of the reconstructed ureter was observed in 1 dog of groups A and C, respectively. Conclusion Reconstruction of ureter by intestinal sero-muscular segment with autograft of bladder mucosa has similar structure and function to the normal ureter. The results might provide an experimental basis for cl inical use.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.
ObjectiveTo systematically review the efficacy and safety of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP) for patients with ureterpelvic junction obstruction (UPJO). MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 11, 2015), Sciverse, VIP, WanFang Data and CNKI from inception to Dec., 2015, to collect randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) about LP versus OP for UPJO patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 38 studies including 8 RCTs and 30 CCTs were included. The results of meta-analysis based on RCTs showed that, there were no significant differences in successful operation rate (OR=0.50, 95%CI 0.20 to 1.24, P=0.13) and the incidence of postoperative complications (OR=1.19, 95%CI 0.61 to 2.31, P=0.62) between the OP group and the LP group; The operation time of the OP group was shorter than that of the LP group (MD=62.07, 95%CI 3.94 to 120.19, P=0.04), but this difference was not found in subgroup analysis of retroperitoneal approach (MD=49.99, 95%CI -23.69 to 123.67, P=0.18); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.96, 95%CI -4.92 to -2.99, P<0.0001). The results of meta-analysis based on CCTs showed that, there was no significant difference in successful operation rate between two groups (OR=1.34, 95%CI 0.84 to 2.16, P=0.22), and similar results were found in subgroup analysis of transperitoneal or retroperitoneal approaches; The incidence of postoperative complications of the LP group was shorter than that of the OP group (OR=0.51, 95%CI 0.37 to 0.69, P<0.0001); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.87, 95%CI -4.90 to -2.83, P<0.00001) and similar result was found in subgroup analysis of transperitoneal approach (MD=-4.08, 95%CI -5.21 to -2.95, P<0.0001); There was no significant difference between two groups in operation time (MD=24.15, 95%CI -7.56 to 55.87, P=0.14). ConclusionCurrent evidence shows that, the successful operation rate between LP and OP operations is similar, but the LP operation has less incidence of postoperative complication and shorter hospital stay. Due to limited quality of the included studies, the above conclusion needs more high quality studies to verify.
ObjectiveTo investigate the necessity of indwelling ureteral stent before flexible ureteroscopic lithotripsy in the treatment of upper urinary tract calculi. MethodsEighty-five patients with upper urinary tract calculi treated between June 2013 and December 2014 were divided into two groups:group A (without indwelling stent, n=42) and group B (with indwelling stent, n=43).Incidence of stent-related urinary tract symptoms, operation time, one-time success rate of placement for ureteral access sheath, and stone clearance rate were compared between the two groups. ResultsThe operation time and stone clearance rate had no statistically significant differences between the two groups (P > 0.05).The incidence of stent-related urinary tract symptoms and one-time success rate of placement for ureteral access sheath in group B were significantly better than those in group A (P < 0.05). ConclusionFor one-phase operation success, we suggest that indwelling ureteral stent is necessary before flexible ureteroscopyic lithotripsy for treating upper urinary tract calculi.
Objective To assess the radiation dose and image quality with low-dose multi-detector row CT urography （CTU） for the evaluation of children patients with ureteropelvic junction stenosis （UJS）. Methods In this prospective study， 30 children patients with UJS underwent CTU were classified half-randomly through exam numbers into 3 groups （115 mA， 100 mA， and 75 mA）. Consecutive acquisitions including CT dose index weighted （CTDIw） and dose long product （DLP） were obtained in each patient and compared for each group. Three experienced chest radio-logists were unaware of the CT technique reviewed CT images for overall image quality using a 3-grade scale （excellent， good， and worst）. The data were analyzed using a parametric analysis of variance test and Wilcoxon’s signed rank test. Results The CTDIws of 115 mA group， 100 mA group， and 75 mA group were （7.63±0.83） mGy， （6.29±0.51） mGy， and （4.72±0.18） mGy， respectively， the difference was significant among three groups （F=36.445， P=0.000）. The mean CTDIw reduction was 38.2% in the 75 mA group as compared with 115 mA group （P＜0.001）. The DLPs of 115 mA group， 100 mA group， and 75 mA group were （173.89±29.88） mGy?cm， （145.96±26.21） mGy?cm， and （102.78±12.72） mGy?cm， respectively， the difference was significant among three groups （F=13.955， P=0.000）. The mean radiation dose reduction was 40.9% （75 mA group versus 115 mA group， P＜0.001）. The assessment of image quality was no significant difference with the same protocol and post-processing technique （Wilcoxon’s signed rank test， P＞0.05）. There was a good agreement for image quality scoring among the three reviewers （Kappa=0.736）. Conclusion Low-dose multi-detector row CTU should be considered as a promising technique for the evaluation of children patients with UJS because it could decrease radiation dose and obtain acceptable image quality.
ObjectiveTo explore the effectiveness of modified Politano-Leadbetter reimplantation for the treatment of congenital malformation of the vesicoureteral junction in children. MethodsA retrospective analysis was made on the clinical data of 53 patients with congenital malformation of the vesicoureteral junction treated with modified Politano-Leadbetter reimplantation between June 2000 and October 2014. Of 53 cases, there were 24 boys and 29 girls, aged from 8 months to 7 years (mean, 2.1 years); 23 had congenital vesicoureteral junction obstruction (14 left, 5 right, and 4 bilateral), and 30 had vesicoureteral reflux (12 unilateral, 18 bilateral), which were verified by voiding cystourethrography. The disease duration was from 1 month to 1 year (mean, 5 months). ResultsAll of the patients underwent modified Politano-Leadbetter reimplantation successfully. The mean operation time was 74 minutes (range, 65-85 minutes) for unilateral cases and 105 minutes (range, 98-130 minutes) for bilateral cases. There was no dysuria, infection of incision, or incision dehiscence after urinary catheter removal. The follow-up time was 6 months to 14 years (median, 28 months); all patients were free from complications of fistula, vesicoureteral reflux, vesicoureteral junction obstruction, or hypertension. The new ureteral orifices had good appearance at 1 month after operation. Urologic ultrasound showed that hydronephrosis relieved at 3 months after operation. Urinary tract infection rate was 13.2% (7/53) during 6 months after operation, which was cured by antibiotics. Voiding cystourethrography showed no vesicoureteral reflux in 32 cases at 6 months after operation. ConclusionThe modified Politano-Leadbetter reimplantation simplifies the operation course, which has the longitudinal ureter after operation and is similar to physiological state. It is a safe and effective option for congenital malformation of vesicoureteral junction in children with few complications, especially for patients with unilateral megaloureter.
Objective To investigate the clinical effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction (UPJO). Methods From November 2010 to September 2015, a total of 28 cases (21 males and 7 females) with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal laparoscopic dismembered pyeloplasty. All the 28 patients had a previous history of different degrees of lumbar pain, which was confirmed as typical UPJO by imaging examination. Operation method: following complete renal pelvis and upper ureter isolation, the renal pelvis was clipped into a trumpet-shaped mouth, 1/3 of the upper renal pelvis was temporarily kept without section. In the inferior margin of renal pelvis, longitudinal cut procedure was operated in the ureter and across the stenotic segment in about 1–2 cm; and then, anastomosis of the ureter and the renal pelvis at the lowest was performed, to maintain the continuity of the renal pelvis and ureter. Subsequently, the stenosed segment of ureter and the dilatant renal pelvis were removed, the posterior ureteropelvic anastomosis was made with an interrupted suture, and antegrade stenting of double J tube was further performed, followed by a continuous suture of the anterior wall. Results The procedure was successfully accomplished in all patients whithout conversion to open surgery. The operating time was 90-240 minutes with the median time of 160 minutes. The estimated blood loss was 20-70 mL with the median of 50 mL. No severe surgical complication occurred in perioperative period. The 3-24 -month follow up showed that symptoms of lumbar pain were relieved or disappeared in all the incorporated patients. Postoperative radiographic examination showed no stomal stenosis at the ureteropelvic junction, and the hydronephrosis was alleviated. Conclusions Retroperitoneal laparoscopic dismembered pyeloplasty for UPJO is an effective, safe, and minimally invasive surgical technique. The key to the success of the operation is to the accurate renal pelvis clipping, tension- and torsion-free anastomosis of the lowest position of the renal pelvis and the ureter, and the reconstruction of a new funnel-shaped ureteropelvic junction.