Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.

Objective:To evaluate the clinical safety and efficacy of using the visual puncture micro-percutaneous nephrolithotomy to treat the mid and distal calculi in children.Methods:From May 2017 to December 2019, 25 children patients with mid and distal ureteric calculi were enrolled into this retrospective study. There were16 males and 9 femals (age range from 2 to 12 years) who were diagnosed by colour doppler ultrasound, CTU, et al. The average stone size was (12±6) mm in diameter (range from 5 to 21 mm). 23 cases got stones in the unilateral ureter and 2 cases in the bilateral ureters, 10 cases in the mid ureter, 15 cases in the distal ureter. 6 cases received ESWL and 3 cases received ureteroscopic lithotripsy, but they were failed. In the lithotomy position, the visual puncture micro-percutaneous nephrolithotomy linked with 0.9% sodium chloride was applied to enter into ureter through urethra. Holmium laser was used for lithotripsy.Result:All the 25 patients were operated successful onestage. The operation time was 15-50 min (32±10) min. All patients were recovery and discharged from hospital 4-7 (6) days later. No calculi moved up and escaped. Serious irritative symptoms of bladder occurred in 2 patients who recovered after pulled out the catheter. Fever (T>38.5℃) occurred in 2 patients who, and they became normal by changed sensitive antibiotic. No severe complications such as ureteral perforation and extravasation occurred. All patients were rechecked by ultrasound and KUB 3 days later, the stone clearance rate was 88%. One month later ultrasound was rechecked, no stone was residual, the stone clearance rate was 100%.Conclusion:As a worth promoting treatment for the mid and distal calculi in children, the visual puncture micro-percutaneous nephrolithotomy is safe, minimally invasive, and effective.

目的 探讨超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石的临床疗效.方法 我院2018年1～8月采用针状可视肾镜联合钬激光碎石术治疗50例无积水肾下盏结石,全身麻醉后输尿管镜下患侧放置F4.8输尿管支架管及F18双腔尿管,膀胱灌注后改俯卧位,在超声定引导、显示器直视下,将针状可视肾镜进入肾下盏,用200μm钬激光光纤,功率0.8 J/10 Hz,将结石粉末化,碎石后加压注水将碎石颗粒冲至肾盂.结果 所有患者均一次性碎石成功,手术时间20～58 min,平均42 min.术后第1天血红蛋白下降0.6～1.3 g/L,平均0.96 g/L.术后发热1例,体温39.0℃,经抗感染、地塞米松磷酸钠注射液后体温恢复正常;术后疼痛5例,给予止痛药物对症止痛后好转;术后出现肉眼血尿8例,未做特殊处理,嘱患者多饮水、休息后好转,均无需输血.术后住院2～6 d,平均3 d.术后第2天复查腹部平片,6例术后碎石已完全排出,其余44例口服排石颗粒,适当倒立体位排石,1个月后复查腹部平片,42例结石完全排出,术后1个月结石清除率96.0％(48/50).术后6个月随访:50例复查彩超,48例双肾未见明显异常,2例右侧肾下盏3～5 mm小结石.结论 超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石安全、有效,结石清除率高.

目的：探讨泌尿外科老年患者术后下肢活动依从性的影响因素。方法选取我院2014年3月—2015年10月收治的泌尿外科老年患者42例为研究对象，随机均分为对照组和观察组，对照组实施常规护理，观察组在常规护理的基础上实施干预护理，采用问卷调查评估2组患者的依从性。结果观察组患者术后下肢活动依从性明显高于对照组，2组比较差异具有统计学意义（P<0.05）。结论根据泌尿外科老年患者的具体情况，在常规护理的基础上实施干预护理，制定合适患者的计划，能有效提高患者对下肢活动的依从性。

目的 探讨标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石的方法及疗效.方法 回顾性分析标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石5610例患者的临床资料.结果 所有患者均成功建立F24经皮肾镜通道,平均手术时间62min,术中失血量50～400ml,结石一期取净率91.2(5112/5610),术中、术后均未发生严重并发症.结论 标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石安全、有效、在治疗复杂上尿路结石方面有良好的应用价值.

<正>马蹄肾是常见的肾脏畸形,常合并肾结石。开放手术创伤大、出血多,体外冲击波碎石术需多次碎石,且不易排出。近年来经皮肾镜手术逐渐成为主要治疗方法。2005年10月至2011年10月,我院采用肾镜下气压弹道及超声碎石清石术治疗马蹄肾肾结石患者35例,效果满意,现报告如下。

【Objiective】To explore the treatment of percutaneous nephrolithotripsy with pneumatic and ultrasonic cystolithotripsy for calculus pyonephrosis.【Methods】From October 2005 to February 2009,79 calculus pyonephrosis patients were treated with percutaneous nephrolithotripsy with pneumatic and ultrasonic cystolithotripsy. 【Results】79 patients were drained clearly,67 patient were lithotripsied completely one time. Only 12 patients accepted the second operation,4 patient accepted extracorporeal shock wave lithotripay. 74 patients renal function recovered,5 patients renal atrophy. 【Conclusions】Percurtaneous nephrolithotripsy with pneumatic and ultrasound cystolithotripsy treating for calculus pyonephrosis is a mini-trauma,effective,safe way.

【Objiective】 To explore the treatment of pneumatic and ultrasound cystolithotripsy and transurethral electrovaporization of the prostate (TUVP) for benign prostatic hyperplasia (BPH) and bladder calculus. 【Methods】From October 2005 to February 2008, Pneumatic and ultrasound cystolithotripsy and TUVP were used to treat 54 cases of BPH and bladder calculus. 【Results】53 patients received lithotripsy and stones were evacuated completely at one time, and then they accepted TUVP. Only 1 patient of bladder diverticula caculus was operated on. 【Conclusion】A combination of pneumatic and ultrasound cystolithotripsy and TUVP is a minimally-invasive, effective way to treat bladder calculus.