Objective To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy (ESWL). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2010), MEDLINE (OVID 1950 to April 2010), EMbase (1979 to April 2010), CBM (1978 to April 2010), CNKI (1979 to April 2010), and VIP (1989 to April 2010), and manually searched journals as well. All the randomized controlled trials (RCTs) of treating ureteral stone with ESWL after stent placement were included. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Three RCTs with C-level evidence involving 319 ureteral stone patients were identified. The results of meta-analyses showed that: a) Effect of treatment: The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate (WMD= 1.10, 95%CI 0.87 to 1.38), the quantity of lithotripsy (WMD= 0.43, 95%CI – 1.05 to 0.19), the frequency of shock wave (WMD= 0.00, 95%CI – 0.25 to 0.25), and the power of shock wave (WMD= 0.20, 95%CI – 0.05 to 0.46); and b) Postoperative complications: The ureteral stent placement were prone to cause dysuria (RR= 2.30, 95%CI 1.62 to 3.26), microscopic hematuria (RR= 2.66, 95%CI 1.97 to 3.58), gross hematuria (RR= 6.50, 95%CI 1.50 to 28.15), pyuria (RR= 1.78, 95%CI 1.44 to 2.21), positive urine culture (RR= 2.13, 95%CI 1.71 to 2.64), and suprapubic pain (RR= 3.10, 95%CI 1.59 to 6.04). Conclusions Ureteral stent placement before ESWL is inadvisable. Multi-factors which lead to bias affected the authenticity of our review, such as low-quality and small amount of RCTs. Further large-scale trials are required.
摘要:目的:分析与比较七氟醚吸入麻醉和丙泊酚静脉复合麻醉应用于三聚氰胺致婴幼儿输尿管结石手术的麻醉效果。方法:60例输尿管结石患儿随机分为七氟醚(Sev)组(n=30)和丙泊酚(Pro)组(n=30)。观察并记录诱导时间、气管内插管时间、苏醒时间、拔除气管插管时间、PACU滞留时间。记录麻醉诱导和苏醒期的不良反应。另外记录两组病人诱导前、插管前、插管后3 min、5 min、15 min、30 min时点的血压、心率、脉搏血氧饱和度(SPO2)。结果:七氟醚组诱导时间(63.2±6.9)s长于丙泊酚组(38.2±12.7)s,七氟醚组拔除气管插管时间(11.9±4.7)min短于丙泊酚组(15.6±8.2)min,两组相比有统计学意义(Plt;0.05)。七氟醚组躁动发生率53.3%显著高于丙泊酚组13.3%(Plt;0.01)。七氟醚组在插管前、插管后各时点的血压、心率与诱导前相比,差异无统计学意义(Pgt;0.05),丙泊酚组插管前、插管后3 min、5 min与诱导前相比血压、心率显著降低(Plt;0.05),与同时间点七氟醚组相比血压显著降低(Plt;0.05)。结论:两种麻醉方法均可安全有效用于婴幼儿输尿管结石手术,七氟醚组血流动力学更平稳,但躁动发生率较高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
ObjectivesTo systematically review the efficacy and safety of doxazosin for ureterolithiasis.MethodsPubMed, EMbase, Web of Science, The Cochrane Library and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of comparing doxazosin with conservative treatment or tamsulosin for ureterolithiasis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 15 RCTs involving 1 062 patients were included. The results of meta-analysis showed that: compared with conservative treatment, doxazosin significantly facilitated ureteral stone expulsion (RR=1.62, 95%CI 1.45 to 1.81, P<0.000 01). No statistical significant difference was found in stone-free rate (RR=0.96, 95%CI 0.83 to 1.11, P=0.57), stone expulsion time (SMD=−0.17, 95%CI −0.52 to 0.19, P=0.35) or pain episode frequency (SMD=0.21, 95%CI −0.15 to 0.56, P=0.25) between doxazosin and tamsulosin. Treatment-associated serious side effects were rarely reported.ConclusionCurrent evidence shows that doxazosin is an efficient and safe medical expulsion agent for ureterolithiasis management. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin. Methods We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts (IPA) Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientific conferences from 2000 to 2006. Randomized controlled trials(RCTs) comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software. Results A total of 16 studies involving 1521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI (1.20 to 1.87), Plt;0.0001], shorter expulsion time [SMD –1.29, 95%CI (–2.27, –0.31)] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI (0.27, 0.59), Plt;0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI (1.31, 1.93)], shorter expulsion time [SMD –0.8, 95%CI (–1.18, –0.42)] and fewer patients requiring ESWL or ureteroscopy [RR 0.13, 95%CI (0.06, 0.31), Plt;0.05]. Compared with deflazacort alone, the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI (0.78, 2.23), P=0.31], but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI (14.98, 15.52)] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09,, 95%CI (0.02, 0.47), Plt;0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI (1.07, 1.35), P=0.002], but similar expulsion time [SMD –1.34, 95%CI (–3.47, 0.79)] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI (0.05, 2.22), Pgt;0.05]. As for side effects, tamsulosin-based treatment and conservative therapy were comparable (Pgt;0.05). Conclusions Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin-based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
目的:探讨B超监测下输尿管镜治疗输尿管结石的临床疗效及可行性。方法:2007年12月~2008年12月采用B超监测下输尿管镜治疗输尿管结石患者34例,结石位于上段4例,中段11例,下段19例。结果:一次性碎石治愈者33例,一次性碎石成功率97%,手术时间(40±15)min,术后2~7天排尽结石,术后住院平均时间3.5(2～5)天。结论:B超监测下输尿管镜治疗输尿管结石对于手术操作者易于随时动态观察结石情况,对于大于0.4 cm的碎石块无遗漏,增加术中一次碎石成功率,可行性高。
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.