Clinical application for female distal ureteric calculi associated with narrow by the F4.8 visual micro-percutaneous nephrolithotomy
10.3760/cma.j.cn112330-20200327-00237
- VernacularTitle:F4.8可视肾镜治疗女性输尿管下段结石合并狭窄的临床应用
- Author:
Wentao ZHANG
1
;
Haisheng QIN
;
Shengjin YANG
;
Junming CHEN
;
Shengli ZHAO
;
Zhaohui YU
;
Cailian DUAN
Author Information
1. 武警河南省总队医院泌尿外科，郑州 450052
- Keywords:
Ureteral calculi;
Visual puncture;
Nephrolithotomy;
Narrow
- From:
Chinese Journal of Urology
2021;42(6):468-471
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.
