Comparison of flexible ureteroscopy and extracorporeal shock wave lithotripsy for residual calculi after single-tract percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2019.04.011

Abstract

Abstract:

Objective

To investigate the clinical effect between flexible ureteroscopy (fURS) and extrocorporeal shock ware lithotripsy (ESWL) in the treatment of residual stones after the management of complex calculi with single-tract percutaneous nephrolithotomy.

Methods

105 patients with complex calculi in our hospital from Jan 2014 to Dec 2016 were selected as study subjects. Among them, 60 patients accepted fURS after single channel PCNL (test group, n=60), and 45 patients accepted ESWL after single channel PCNL (control group, n=45). General data, perioperative parameters and complications of the two groups were analyzed and compared.

Results

The experimental group were significantly better than the control group in terms of average operation time, operation success rate, stone clearance rate, and the need for re-treatment rate (t or χ² were 6.255, 7.415, 9.358, 10.423, respectively; P values were 0.000, 0.006, 0.002, and 0.001, respectively). The cases of complications in postoperative pain and renal dysfunction in the experimental group was less than that in the control group, and the overall complication rate in the experimental group was significantly lower than that in the control group (χ²=6.369, P=0.012).

Conclusion

As for patients with residual calculus after single-channel PCNL, compared with ESWL, the stone clearance rate of fURS treatment is higher, and the postoperative complications are lower, with higher safety, which is worthy of clinical promotion.

Key words: Flexible ureteroscopy, Holmium laser, ESWL, Complex calculi, Residual stones

Haibao He, Suomin Liu, Jianxun Zhang, Danfeng Gao, Gang Wang. Comparison of flexible ureteroscopy and extracorporeal shock wave lithotripsy for residual calculi after single-tract percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(04): 259-262.

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References 19

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因素		试验组	对照组	统计值	P值
总病例数		60	45	?	?
BMI（kg/m²，±s）		26.2±1.6	26.2±1.5	t=0.03	0.97
糖尿病史（例）		6	5	χ²=0.02	0.89
有高血压病史（例）		8	6	χ²=0	1
有高血脂病史（例）		5	5	χ²=0.02	0.89
肾积水程度（例）		?	?	χ²=0	1
?	轻度	18	16	?	?
?	中度	30	19	?	?
?	重度	12	10	?	?
血尿素氮（mmol/L，±s）		4.6±1.6	4.6±1.4	t=0.17	0.87
血肌酐（μmol/L，±s）		99±26	101±29	t=0.35	0.72
PCNL术后结石大小（mm，±s）		16.0±3.1	16.1±3.3	t=0.19	0.85
PCNL术后结石表面积（mm²，±s）		180±144	171±136	t=-0.35	0.73
残余结石数量（个，±s）		1.62±1.02	1.58±0.88	t=-0.22	0.83
残余结石定位[例（%）]		?	?	χ²=0.02	0.88
?	肾上盏	10（16.67）	7（15.56）	?	?
?	肾中盏	5（8.33）	3（6.67）	?	?
?	肾下盏	34（56.67）	26（57.78）	?	?
?	肾上盏+肾中盏	6（10）	5（11.11）	?	?
?	肾上盏+肾下盏	6（10）	4（8.89）	?	?

因素		试验组	对照组	统计值	P值
总病例数		60	45	?	?
BMI（kg/m²，±s）		26.2±1.6	26.2±1.5	t=0.03	0.97
糖尿病史（例）		6	5	χ²=0.02	0.89
有高血压病史（例）		8	6	χ²=0	1
有高血脂病史（例）		5	5	χ²=0.02	0.89
肾积水程度（例）		?	?	χ²=0	1
?	轻度	18	16	?	?
?	中度	30	19	?	?
?	重度	12	10	?	?
血尿素氮（mmol/L，±s）		4.6±1.6	4.6±1.4	t=0.17	0.87
血肌酐（μmol/L，±s）		99±26	101±29	t=0.35	0.72
PCNL术后结石大小（mm，±s）		16.0±3.1	16.1±3.3	t=0.19	0.85
PCNL术后结石表面积（mm²，±s）		180±144	171±136	t=-0.35	0.73
残余结石数量（个，±s）		1.62±1.02	1.58±0.88	t=-0.22	0.83
残余结石定位[例（%）]		?	?	χ²=0.02	0.88
?	肾上盏	10（16.67）	7（15.56）	?	?
?	肾中盏	5（8.33）	3（6.67）	?	?
?	肾下盏	34（56.67）	26（57.78）	?	?
?	肾上盏+肾中盏	6（10）	5（11.11）	?	?
?	肾上盏+肾下盏	6（10）	4（8.89）	?	?

组别	例数	手术时间（mm，±s）	手术成功率（%）	结石清除率（%）	再次治疗率（%）
试验组	60	39.9±7.8	85.80	93.60	7.90
对照组	45	51.5±11.2	62.30	70.40	34.20
统计值	?	t=6.255	χ²=7.415	χ²=9.358	χ²=10.423
P值	?	0.000	0.006	0.002	0.001

组别	例数	手术时间（mm，±s）	手术成功率（%）	结石清除率（%）	再次治疗率（%）
试验组	60	39.9±7.8	85.80	93.60	7.90
对照组	45	51.5±11.2	62.30	70.40	34.20
统计值	?	t=6.255	χ²=7.415	χ²=9.358	χ²=10.423
P值	?	0.000	0.006	0.002	0.001

组别	例数	尿路感染	肉眼血尿	疼痛	泌尿系损伤	肾功能减退	合计
试验组	60	1	2	1	0	1	5
对照组	45	1	2	5	0	4	12
χ²值	?	?	?	?	?	?	6.369
P值	?	?	?	?	?	?	0.012

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