1Department of Urology, China-Japan Union Hospital, Jilin University, Changchun 130031, China; 2Department of Orthopedics, the First Bethune Hospital of Jilin University; 3Fengman District Center of Disease Control and Prevention
Abstract：Objective:To study and explore the safety of the visual auxiliary puncture in percutaneous nephrolithotomy without hydrocele to treat the kidney stones. Methods:From June 2016 to March 2017, our department has treated 21 cases of non-hydrocele kidney stones by the techniques of the visual auxiliary puncture. For all of the 21 cases, no hydrocele has been detected by the preoperative computed tomography (CT) and intravenous pyelography. First ureteral retrocatheterism was implemented in the lithotomy position, and then normal saline was instilled to form the artificial hydronephrosis to make way for ultrasonic location. Under the guidance of ultrasound, the puncture was done with the aid of the visual nephroscope system. After confirming the entrance into the collecting system, according to the size of the kidney stones, F12 ultrafine channels, F18 micro channels or F24 standard channels were established. When the channels were set up successfully, the steps of removing calculus were carried out. Results:Among the 25 cases of channel puncture, including the second operative channel, 22 succeeded in a one-time success. In the rest 3 cases, renal parenchyma had bleeding in direct vision during the puncture, but a change in the position of puncture finally led to the success in entering the collecting system. Duration of the operation was 25-90 min, with an average of (45±22) min. There was no obvious change in hemoglobin before and after operation. No treatment for the thromboembolic hemostasis was given. Fever occurred in 1 case, and improved after positive anti-inflammatory treatment in accordance with the symptoms. No pelvic perforation or enterocoelia visceral organic injuries occurred. At 5th-7th day postoperation, KUB or B-ultrasonography revealed the kidney stones were removed completely in 19 cases (90.5%), and 2 cases (9.5%) had residual small stones. Conclusions:The visual auxiliary puncture in percutaneous nephrolithotomy without hydrocele to treat the kidney stones can significantly increase the success rate of the operations, effectively avoiding the injuries of the collecting system and blood vessels as well as the inside organs, with less bleeding, shorter operation time and less infections. It is proved to be safe to carry out the visual auxiliary puncture in percutaneous nephrolithotomy without hydrocele to treat the kidney stones, esp. when the young doctors are not so experienced, with the benefit of increasing the success rate for the kidney puncture in the operations.
