Abstract：Objective： To evaluate the feasibility and safety of retrograde intrarenal surgery (RIRS) in treating upper urinary calculi. Methods： The clinical data of 75 patients with upper urinary calculi who underwent RIRS during 2016 and 2018 were retrospectively reviewed. Twenty-four patients with urosepsis served as urosepsis group and 51 patients without urosepsis as non-urosepsis group. All patients underwent the drainage by inserting a double-J ureteral stent under retrograde cystoscope and controlled infection before RIRS. Specially, the ureteral stent insertion was performed immediately when patients were diagnosed as urosepsis. The operation was performed after infection control. The operation time, the loss of hemoglobin post-operation, the increase of white blood cell post-operation, the increase of serum procalcitonin (PCT) post-operation, post-operative hospital stay, stone-free rate (SFR) and surgery-related complications were compared between the two groups. Results： There were no statistically significant differences in terms of the operation time, the loss of hemoglobin post-operation, the increase of white blood cell post-operation, the PCT post-operation, post-operative hospital stay, SFR and surgery-related complications (P > 0.05). Significant difference was found between the two groups in regard to post-operative hospital stay [(3.3±1.2) d vs. (2.6±1.1) d, t=2.235, P=0.028]. Conclusions： The upper ureter calculi with urosepsis is a dangerous disease. RIRS is the save and effective treatment after drainage with a double-J tube and infection control. It's worthy to be widely applied in all kinds of hospitals.
[1] 康家旗,杨永姣,刘莉,等.输尿管结石致尿脓毒血症患者发生严重脓毒症或脓毒性休克的危险因素分析.重庆医科大学学报,2018,43(4):556-559. [2] YOSHIMURA K, UTSUNOMIYA N, ICHIOKA K, et al.Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol, 2005,173(2):458-462. [3] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:212-213. [4] WAGENLEHNER FE, CHRISTOPH L, CAROLINE R, et al.Diagnosis and management for urosepsis. Int J Urol, 2013,20(10):963-970. [5] 申吉泓,张白羽.泌尿外科医生必须高度重视的尿源性脓毒血症.现代泌尿外科杂志,2014,19(4):219-221. [6] 萨音白刚. 输尿管软镜钬激光碎石术在上尿路结石中的应用.临床医药文献电子杂志,2014,37(11):1949-1950. [7] MARTOV A, GUDKOV A, DIAMANT V, et al.Investigation of differences between nanosecond electropulse and electrohydraulic methods of lithotripsy: a comparative in vitro study of efficacy. J Endourol, 2014,28(4):437-445. [8] 顾志文,郑彬,罗发彩,等.输尿管硬镜与软镜治疗10~20 mm输尿管上段结石的比较.中国微创外科杂志,2018,18(9):814-818. [9] 徐明曦,张明,张克,等.输尿管软镜下钬激光碎石术治疗上尿路结石80例报告.现代泌尿外科杂志,2013,18(6):620-621,626. [10] 刘霄鹏,傅发军,黎勇林,等.输尿管软镜技术治疗输尿管上段结石手术技巧探讨.国际泌尿系统杂志,2016,36(6):839-841. [11] 赖德辉,李逊,何永忠,等.经皮肾镜取石术和输尿管软镜碎石术治疗肾结石(>2cm)并发症的Meta分析.现代泌尿外科杂志,2016,21(4):283-288. [12] 张弋,于澄钒,朱鹤,等.斜仰卧位微创经皮肾镜和输尿管软镜治疗输尿管上段结石的非随机比较研究.中华泌尿外科杂志,2013,34(10):775-778. [13] 郑杨灿,吕宗凯,杨小秋,等.输尿管软镜治疗输尿管上段结石的系统评价.医学综述,2016,22(7):1374-1378. [14] COHEN J, COHEN S, GRASSO M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int, 2013,111(3 Pt B)E127-E131.
