The application of lateral decubitus position in ureteroscopic lithotripsy for the treatment of upper ureteral calculi
Li Binbin1, Zhang Jinqing2, Tan Xingyin1, Luo Fei1, Hou Guoliang1
1Department of Urology, the First People's Hospital of Foshan, the Affiliated Foshan Hospital of Sun Yat-sen University 528000, China;
2Department of Urology, Xiaolan Hospital of Southern Medical University
Abstract：Objective: To investigate the feasibility and clinical value of lateral decubitus position in ureteroscopic lithotripsy for the treatment of upper ureteral calculi. Methods: We retrospectively reviewed the data of patients with upper ureteral calculi, including 280 cases treated by lateral decubitus position and 212 cases treated by supine lithotripsy from January 2015 to July 2017 in two hospitals. The achievement ratio of lithotripsy, the time of operation, the incidence of complications and the average hospitalization time after operation were compared between the two groups. The reasons why lateral position significantly improved the success rate of ureteroscopic lithotripsy were analyzed. Results: The achievement ratio in one operation was 89.28% (250/280) and total achievement ratio was 92.14% (258/280) in lateral position group, and that was 67.92% (144/212) and 78.77% (167/212) respectively in supine lithotripsy group. The difference between the two groups was significant (P<0.001). There was no significant difference between the two groups in the mean operation time, postoperative hospitalization time and the incidence of complications (P>0.05). The main failure factor was stone escape [57.78% (26/45)] in supine lithotripsy group, and the failure rate was only 18.18% (4/22) in lateral position group. Ureteral stenosis was another failure factor in both groups. Failure cases were further treated by percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy, open surgery, etc. Conclusions: Compared with supine lithotripsy, ureteroscopic lithotripsy in lateral decubitus position can more effectively prevent the upper ureteral stones from moving into the renal calyx, which can help keep the stone in the range of visual field, increase the success rate of lithotripsy, and avoid conversion to open operation. It can treat bilateral calculi at the same time and reduce the economic burden of patients. It provides a feasible new method for the treatment of upper ureteral calculi.
李彬彬, 张劲勍, 谭兴银, 罗飞, 侯国良. 侧卧位输尿管镜碎石术在输尿管上段结石治疗中的临床应用价值[J]. 微创泌尿外科杂志, 2018, 7(6): 379-384.
Li Binbin, Zhang Jinqing, Tan Xingyin, Luo Fei, Hou Guoliang. The application of lateral decubitus position in ureteroscopic lithotripsy for the treatment of upper ureteral calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(6): 379-384.
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