Application of minimally invasive percutaneous nephrolithotomy under local anesthesia accompanied with stimulated diuresis for treating upper urinary calculi
ZHENG Liangliang1, KUANG Renrui1, DENG Jun1, LI Jin1, LIU Wei1, GONG Zhixian2, LIU Mei3, ZHANG Xuehong4, WANG Longwang1
1Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China; 2Department of Day Care, the First Affiliated Hospital of Nanchang University; 3Department of Anesthesiology, the First Affiliated Hospital of Nanchang University; 4Department of Urology, Nanchang County People's Hospital
Abstract：Objective: To explore the feasibility and safety of minimally invasive ultrasonography-guided percutaneous nephrolithotomy (mPCNL) for treating upper urinary calculi under local infiltration anesthesia accompanied with stimulated diuresis. Methods: A retrospective analysis was performed on the clinical data of 90 patients who suffered from upper urinary calculi and underwent mPCNL with local anesthesia from July 2017 to June 2019, including 57 males and 33 females with the age ranging from 22 to 71 years old (mean 38.3±10.7 years old). The long diameter of the calculi ranged from 1.6 to 4.5 cm, with an average of (3.1±1.3) cm. At 30 min preoperation, diuretic was given to produce artificial hydronephrosis. Under the local infiltration anesthesia, ultrasonography-guided percutaneous punctures for mPCNL were carried out. Visual analogue scale (VAS) was used to assess the severity of pain at 0, 6, 24 and 48 h postoperatively. The demographic characteristics and the stone characteristics were evaluated to determine the feasibility. The complications were evaluated to determine the safety. The stone-free rate was evaluated to determine the effectiveness. Results: The effect of local anesthesia during operation was satisfactory, and all cases were operated under local anesthesia. The mean ASA score was (1.5±0.4). The mean operative time was (56±25.8) min. The mean VAS scores at 0, 6, 24 and 48 h postoperatively were 2.5, 2.2, 1.6 and 0.7 respectively, one patient (1.1%) required selective renal angioembolism, 10 patients (11.1%) received analgesic treatment after operation within 24 h, 78 patients (86.7%) were not given drainage tube, 12 patients (13.3%) were given drainage tube, and average retention time was (3.2±0.6) days. The average length of stay after surgery was (2.6±0.5) days for tubeless patients. Stone-free rate (SFR) of the first stage was 92.2% (83/90). Conclusion: By diuretic to produce artificial hydronephrosis, ultrasonography-guided percutaneous nephrolithotomy under the local infiltration anesthesia for mPCNL has the advantages of shorter preoperative preparation time, less trauma, lower incidence of complications, quicker recovery, and higher stone-free rate, and can be used as a treatment for upper urinary calculi.
郑亮亮, 匡仁锐, 邓君, 李金, 刘伟, 龚智娴, 刘梅, 张学宏, 汪隆旺. 刺激性利尿局麻微创经皮肾镜取石术在上尿路结石中的应用[J]. 微创泌尿外科杂志, 2020, 9(4): 240-244.
ZHENG Liangliang, KUANG Renrui, DENG Jun, LI Jin, LIU Wei, GONG Zhixian, LIU Mei, ZHANG Xuehong, WANG Longwang. Application of minimally invasive percutaneous nephrolithotomy under local anesthesia accompanied with stimulated diuresis for treating upper urinary calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(4): 240-244.
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