Analysis of 64 cases of complicated renal calculi treated by ultrasoundguided total urinary tract breakthrough technique combined with EMS ultrasonic pneumatic lithotripsy system

OBJECTIVE Methods and advantages of combining the ultrasound-guided total urinary tract breakthrough technique with the EMS ultrasonic pneumatic lithotripsy system in the treatment of complicated renal calculi were explored.METHODS 64 patients with complicated renal calculi,including 41 males and 23 females,were studied.Ages of the patients ranged from 24 to 64 years ago,with an average age of 41.Diameters of renal calculi of the patients were between 1.0 and 3.5 cm;55 cases had a single renal calculus,and 9 cases suffered from multiple renal calculi;staghorn calculi and cast calculi were observed in 4 and 11 cases,respectively.29 cases had renal calculi on the left side of their body,30 cases had right-side renal calculi,and 5 cases had bilateral calculi.2 cases had undergone renal surgery,26 cases had infection in the urinary system,and 8 cases had renal dysfunction,including 6 azotemia and 2 uremia cases.All 64 patients were subjected to a combination treatment,in which ultrasound-guided total urinary tract breakthrough technique was used in conjunction with the EMS ultrasonic pneumatic lithotripsy system.RESULTS 24F working channels for percutaneous nephroscopy were successfully created on 68 sides of the 64 patients.Phase I lithotripsy on 61 sides,Phase II on 3 sides,and Phase I 2-center-channel lithotripsy on 2 sides were conducted;in addition,1 case received a simultaneous bilateral lithotripsy,and 1 other case received a 2-channel-on-1-side lithotripsy.The average surgery time was 103 min,and the average post-surgerical hospitalization time was 6.5 days.Clearance rate of Phase I lithotripsy was 90.6%(58/64),and the overall calculi clearance rate was 93.7%(60/64).No pneumothorax,abdominal organ injury,or other severe complications occurred during the surgeries.The patients were examined 3 to 5 days after an ultrasound or KUB surgery;11 cases had residual calculi,with the largest calculi diameter being 0.3 to 1.2 cm.3 cases were supplementarily treated with an extracorporeal shock wave lithotripsy(ESWL) after the surgery,while 9 cases with calculi diameters of less than 4 mm were conservatively treated with oral medicines.Double-J tubes were removed from the patients within 3 to 10 weeks,and all patients were followed up for 1 to 6 months after the surgeries.Among the 8 patients with renal dysfunction,3 cases showed normal serum creatinine level 1 month after the surgery,while serum creatinine levels in 3 other cases remained unchanged(the difference in SCr level was less than 5 mmol/L) and the 2 remaining cases had aggravated serum creatinine levels.No recurrence of renal calculi was observed in 58 followed-up cases for 3-24 months.CONCLUSION Combining ultrasound-guided total urinary tract breakthrough techniques with EMS ultrasonic pneumatic lithotripsy in the treatment of complicated renal calculi is highly effective and low in complications,and has demonstrated to be an ideal regimen for the treatment of complicated renal calculi.