ObjectiveTo explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.

METHODSThis study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.

RESULTSOf the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.

CONCLUSIONSThe F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.

Calculi ; diagnostic imaging ; surgery ; Ejaculatory Ducts ; Endoscopes ; Endoscopy ; instrumentation ; Genital Neoplasms, Male ; Hemospermia ; diagnosis ; therapy ; Holmium ; Humans ; Lasers, Solid-State ; Lithotripsy ; Magnetic Resonance Imaging ; Male ; Natural Orifice Endoscopic Surgery ; instrumentation ; Neoplasm Recurrence, Local ; Postoperative Complications ; Reproducibility of Results ; Seminal Vesicles ; diagnostic imaging ; Urethra

Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL.
Catheters, Indwelling ; Drainage ; Humans ; Kidney Calculi/*surgery ; Lithotripsy/instrumentation ; Nephrostomy, Percutaneous/*instrumentation/*methods ; *Patient Positioning ; *Postoperative Care ; Radiology, Interventional ; Ultrasonography, Interventional

OBJECTIVETo study the value of rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis under the guidance of three-dimensional visualization technology.

METHODSThe 26 patients with hepatolithiasis from February 2012 to June 2013 were analyzed. There were 11 male and 15 female patients with a median age of 55.2 years (range 31-75 years old). The image data of CT scanning of hepatolithiasis were introduced into medical image three-dimensional visualization system (MI-3DVS) for three-dimensional reconstruction, 3D classifications of hepatolithiasis were obtained based on it. Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology.

RESULTSThe 26 patients (29 times) experienced targeting treatment of rigid choledochoscope and pneumatic lithotripsy under the guidance of three-dimensional visualization technology, including:19 cases (4 cases of type IIc) through percutaneous biliary tract sinus, laparoscopic surgery 3 cases, laparotomy 4 cases. Three patients underwent surgery twice. The final stone clearance rate was 100%.One case confirmed combined with cholangiocarcinoma and transfer to radical resection.Intraoperative blood loss was (41.7 ± 8.5) ml, operating time was (100.8 ± 7.6) minutes, and postoperative hospital stay was (7.0 ± 0.6) days. A patient suffered postoperative biliary tract bleeding.Without bile duct injury, bleeding, bile leakage and other complications were occurred.

CONCLUSIONRigid choledochoscope and pneumatic lithotripsy in the treatment of hepatolithiasis under the guidance of three-dimensional visualization technology achieved digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliary surgery.

Adult ; Aged ; Bile Ducts, Intrahepatic ; surgery ; Cholelithiasis ; surgery ; Endoscopes ; Endoscopy ; instrumentation ; Female ; Humans ; Imaging, Three-Dimensional ; Lithotripsy ; methods ; Male ; Middle Aged ; Treatment Outcome

The author reviewed technical improvements of XYS.SUI-6X extracorporeal shock wave lithotriptor and illustrated the clinical efficacy of the lithotriptor with clinical study based on clinical trial after its upgraded, which curative ratio and effective ratio were increased to 76.67% and 20.00% respectively. Total cure and relief rate was 96.67%, invalidation was 3.33%, the results were better than the outcomes before its improvements.
Adult ; Equipment Design ; Female ; Humans ; Lithotripsy ; instrumentation ; methods ; Male ; Middle Aged

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.
Abdominal Pain/etiology ; Balloon Dilation ; Calcinosis/complications/diagnosis/physiopathology/surgery/*therapy ; Calculi/diagnosis/etiology/physiopathology/surgery/*therapy ; *Endoscopy/instrumentation ; Evidence-Based Medicine ; Humans ; Lithotripsy ; Pancreatic Ducts/physiopathology/*surgery ; Pancreatitis, Chronic/complications/diagnosis/physiopathology/surgery/*therapy ; Sphincterotomy, Endoscopic ; Stents ; Treatment Outcome

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Device Removal/*methods ; Diagnosis, Differential ; Equipment Failure ; Gallstones/radiography/*therapy ; Humans ; Lithotripsy/*instrumentation ; Male ; Radiography, Interventional ; Tomography, X-Ray Computed ; Traction/instrumentation

OBJECTIVETo discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi.

METHODSA total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi.

RESULTSPCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successful rate of puncture was 100% without occurrence of severe injury of the pleura, intestine, peritoneum or other adjacent organs.

CONCLUSIONSPercutaneous nephrolithotomy through the upper pole calix access allows greater stone clearance rate due to its easy access into the intrarenal collecting system and can be an ideal approach for PCNL for complicated renal calculi.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Calculi ; surgery ; Kidney Calices ; Lithotripsy ; methods ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Nephrostomy, Percutaneous ; methods ; Young Adult

OBJECTIVETo evaluate the efficacy of alpha1-adrenergic antagonist in the medical management of lower ureteral stone with extracorporeal shock wave lithotripsy (ESWL).

METHODSA total of 80 patients with stone located in lower ureter were randomly divided into two groups. Group 1 served as control and group 2 received tamsulosin (0.4 mg, once daily) after ESWL. All patients were observed for 2 weeks and asked to compile a diary about renal colic, stone expulsion, use of analgesic drugs, and side effects of medical therapy.

RESULTSDuring 2 weeks, stones were expulsed in 18 patients (45.0%) of group 1 and in 31 patients (77.5%) of group 2. The expulsion rate between group 1 and group 2 was significantly different (P < 0.01). Eight patients (20.0%) in group 1 and 2 patients (5.0%) in group 2 experienced renal colic relapse within 2 weeks and were administered with analgesics (P < 0.05). No side effect in group 1 was reported, except that 2 patients in group 2 complained of slight dizziness.

CONCLUSIONSTamsulosin (alpha1-adrenergic antagonist) can improve the stone-free rate of lower ureteral stones after ESWL and reduce the relapse of renal colic. As a safe and effective agent, it can be regarded as an auxiliary clearance method after ESWL for lower ureteral stones.

Adrenergic alpha-Antagonists ; administration & dosage ; Adult ; Combined Modality Therapy ; Female ; Humans ; Lithotripsy ; instrumentation ; Male ; Middle Aged ; Sulfonamides ; administration & dosage ; Ureteral Calculi ; drug therapy ; therapy ; Young Adult

Humans ; Lithotripsy ; instrumentation ; methods ; Ureteral Calculi ; therapy

OBJECTIVETo evaluate the effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi.

METHODSUreteroscopic holmium: YAG laser lithotripsy was used in 168 ureteral calculi (proximal 27 cases, middle 33 cases, distal 108 cases). Transurethral cystoscopic holmium: YAG laser lithotripsy in 12 bladder calculi.

RESULTSFour to six weeks after operation, The stone-free rate was 93% (25/27) in the proximal ureteral calculi, 94% (31/33) in the middle ureteral calculi, 94% (102/108) in the distal ureteral calculi, respectively. The complication rate was 5% (8 cases). the stone-free rate of bladder calculi was 100% (12/12), no complication.

CONCLUSIONUreteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Aged ; Aged, 80 and over ; Holmium ; Humans ; Intraoperative Complications ; Lithotripsy, Laser ; instrumentation ; methods ; Male ; Middle Aged ; Postoperative Complications ; Treatment Outcome ; Ureteroscopy ; Urinary Calculi ; therapy