The feasibility of flexible ureteroscopy with holmium laser lithotripsy in treating upper urinary stones in solitary kidneys

doi:10.3877/cma.j.issn.1674-3253.2021.01.007

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of flexible ureteroscopy with holmium laser lithotripsy in treating upper urinary stones in solitary kidneys.

Methods

In our hospistal, from October 2015 to September 2018, 64 patients with upper urinary stones equally in solitary kidneys or non-solitary kidneys were treated with flexible ureteroscopic lithotripsy, which were classified as solitary kidneys group and non-solitary kidneys group in this study. The two groups were compared and analyzed statistically in terms of demographic and clinical characteristics, operation time, stone-free rate, surgical-related complications rate and postoperative hospital stay.

Result

Successful access was achieved in all the patients. There was no significant difference between the two groups in terms of operation time, postoperative hospital stay, stone-free rate or surgical-related complications (fever, bleeding, renal faiure, steinstrasse or ureteral stricture) rate. The blood urea nitrogen (BUN) in both groups decreased significantly after the procedure (P<0.05), while the serum creatinine (SCr) were maintained similar to that before the procedure in two weeks with no significance (P>0.05) though it increased in the solitary kidneys group temporarily one day after the procedure with statistical significance (P<0.05).

Conclusions

Flexible ureteroscopy with holmium laser lithotripsy is safe and feasible for treating upper urinary stones in solitary kidneys, and could be recommended to clinical surgeons.

Key words: Flexible ureteroscopy, Solitary kidney, Kidney stone, Ureteral stone

Zhiwen Gu, Bin Zheng, Rizhao Tan, Heqing Zhang, Facai Luo, Yue Chen. The feasibility of flexible ureteroscopy with holmium laser lithotripsy in treating upper urinary stones in solitary kidneys[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(01): 25-28.

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References 19

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组别	例数	年龄（岁，±s）	性别（例）		肾积水（例）			预留双J管（例）		结石位置（例）			结石最大径（mm，±s）
组别	例数	年龄（岁，±s）	男	女	无	轻度	中度	有	无	输尿管上段	肾下盏	肾盂及其它肾盏	结石最大径（mm，±s）
孤立肾组	32	59±8.2	21	11	8	18	6	18	14	7	13	12	15.1±5.2
非孤立肾组	32	58±13	15	17	7	20	5	15	17	12	9	11	13.8±3.6
统计值		t=0.341	χ²=2.286		Z =-0.15			χ²=0.563		χ²=2.087			t=1.154
P值		0.734	0.131		0.988			0.453		0.352			0.254

组别	例数	年龄（岁，±s）	性别（例）		肾积水（例）			预留双J管（例）		结石位置（例）			结石最大径（mm，±s）
组别	例数	年龄（岁，±s）	男	女	无	轻度	中度	有	无	输尿管上段	肾下盏	肾盂及其它肾盏	结石最大径（mm，±s）
孤立肾组	32	59±8.2	21	11	8	18	6	18	14	7	13	12	15.1±5.2
非孤立肾组	32	58±13	15	17	7	20	5	15	17	12	9	11	13.8±3.6
统计值		t=0.341	χ²=2.286		Z =-0.15			χ²=0.563		χ²=2.087			t=1.154
P值		0.734	0.131		0.988			0.453		0.352			0.254

组别	例数	手术时间（min）	术后住院天数（d）	手术并发症
组别	例数	手术时间（min）	术后住院天数（d）	发热	出血	肾功能衰竭	石街形成	输尿管狭窄形成	总体并发症发生率
孤立肾组	32	55.9±25.5	4.1±3.8	12.5%(4/32)	0%(0/32)	3.1%(1/32)	0.0%(0/32)	0.0%(0/32)	15.6%(5/32)
非孤立肾组	32	50.3±22.4	3.1±1.4	09.4%(3/32)	3.1%(1/32)	0.0%(0/32)	3.1%(1/32)	3.1%(1/32)	18.8%(6/32)
统计值		t=0.937	t=1.345	χ²=0.000	-	-	-	-	χ²=0.110
P值		0.353	0.186	1.000	1.000	1.000	1.000	1.000	0.740

组别	例数	手术时间（min）	术后住院天数（d）	手术并发症
组别	例数	手术时间（min）	术后住院天数（d）	发热	出血	肾功能衰竭	石街形成	输尿管狭窄形成	总体并发症发生率
孤立肾组	32	55.9±25.5	4.1±3.8	12.5%(4/32)	0%(0/32)	3.1%(1/32)	0.0%(0/32)	0.0%(0/32)	15.6%(5/32)
非孤立肾组	32	50.3±22.4	3.1±1.4	09.4%(3/32)	3.1%(1/32)	0.0%(0/32)	3.1%(1/32)	3.1%(1/32)	18.8%(6/32)
统计值		t=0.937	t=1.345	χ²=0.000	-	-	-	-	χ²=0.110
P值		0.353	0.186	1.000	1.000	1.000	1.000	1.000	0.740

观察指标	组别	例数	术前1天_①	术后1天_②	术后2周内最低值_③	Z_①-②，P_①-②	Z_①-③，P_①-③
血肌酐（μmol/L）	孤立肾组	32	129.5(79.0～556.0)	145.5(89.0～528.0)	130.5(69.0～302.0)	-2.123，0.034	-0.496，0.620
血肌酐（μmol/L）	非孤立肾组	32	077.0(42.0～372.0)	79.0(19.0～319).	079.0(19.0～293.0)	-0.255，0.799	-0.216，0.829
血尿素氮（mmol/L）	孤立肾组	32	8.0(4.8～28.0)	6.9(3.7～19.6)	6.3(3.7～17.5)	-2.328，0.020	-3.459，0.001
血尿素氮（mmol/L）	非孤立肾组	32	5.3(3.6～20.2)	5.0(2.2～15.1)	5.0(2.2～15.1)	-2.141，0.032	-2.160，0.031

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