Fragments and dust after Holmium laser lithotripsy with or without “Moses technology”: How are they different?

Urinary stones can be readily disintegrated by Holmium:YAG laser (Holmium laser lithotripsy), resulting in a mixture of small stone dust particles, which will spontaneously evacuate with urine and larger residual fragments (RF) requiring mechanical retrieval. Differences between fragments and dust have not been well characterized. Also, it remains unknown how the recently introduced “Moses technology” may alter stone disintegration products. Three complementary analytical techniques have been used in this study to offer an in‐depth characterization of disintegration products after in vitro Holmium laser lithotripsy: stereoscopic microscopy, scanning electron microscopy and Fourier‐transform infrared spectroscopy. Dust was separated from fragments based on its floating ability in saline irrigation. Depending on initial crystalline constituents, stone dust either conserved attributes found in larger RFs or showed changes in crystalline organization. These included conversion of calcium oxalate dihydrate towards calcium oxalate monohydrate, changes in carbapatite spectra towards an amorphous phase, changes of magnesium ammonium phosphate towards a differing amorphous and crystalline phase and the appearance of hydroxyapatite on brushite fragments. Comparatively, “Moses technology” produced more pronounced changes. These findings provide new insights suggesting a photothermal effect occurring in Holmium laser lithotripsy. Figure: Appearance of hydroxyapatite hexagons on stone dust collected after Holmium laser lithotripsy of a brushite stone using “Moses technology.”      

输尿管软镜结合输尿管硬镜治疗复杂上尿路结石的效果评价及对预后的影响

目的 探讨输尿管软镜协同输尿管硬镜治疗复杂上尿路结石的临床效果.方法 选择我院收治的复杂上尿路结石患者96例,按入院顺序分为对照组和观察组,每组48例.对照组采取输尿管硬镜钬激光碎石术治疗,观察组采取输尿管软镜协同输尿管硬镜钬激光碎石术治疗.比较两组患者1次性碎石成功率、结石彻底清除率、炎症反应情况以及生活质量、住院时...     

输尿管软镜与经皮肾镜钬激光碎石术对肾结石患者肾功能的影响

目的：观察输尿管软镜下钬激光碎石术与经皮肾镜下钬激光碎石术治疗肾结石对患者肾功能影响。方法：选择本院于2012 年5 月-2015 年5 月收治的单发肾结石且结石直径均≤ 2 cm的患者180 例作为研究对象,根据配对分组法分为两组,每组90 例,A组采取输尿管软镜下钬激光碎石术治疗,B组采取经皮肾镜下钬激光碎石术治疗。分别于手术前后测定两组患者尿Kim-1 及血清NGAL、Cys-C水平,评估患者肾功能。结果：两组术前及术后6 h、12 h、24 h、72 h尿Kim-1 水平比较均无统计学差异（P>0. 05）;A 组术后48 h尿Kim-1 水平显著低于B组（P<0.05）。两组术后6 h、12 h、24 h尿Kim-1 水平均高于术前（P<0.05）。两组术后 6 h、12 h、24 h、48 h、72 h血清NGAL水平均高于术前,P<0.05。两组患者术前2 h、术后6 h血清Cys-C 水平均无显著统计学差异 （P>0.05）;术后12 h、24 h、48 h、72 h血清Cys-C 水平均A 组均高于B 组（P<0.05）。结论：输尿管软镜下钬激光碎石术与经皮肾镜 下钬激光碎石术治疗肾结石均对患者肾功能造成损伤,但输尿管软镜下钬激光碎石术对肾小球损伤更为严重,经皮肾镜下钬激 光碎石术对肾小管损伤较为严重,临床应注意。     

经尿道输尿管镜钬激光碎石术后尿路感染的影响因素及其对患者细胞免疫功能和生活质量的影响

摘要 目的：探讨经尿道输尿管镜钬激光碎石术后尿路感染的影响因素及其对患者细胞免疫功能和生活质量的影响。方法：选择2019年6月-2021年1月期间来我院接受经尿道输尿管镜钬激光碎石术治疗的150例患者。采用流式细胞仪检测T淋巴细胞亚群指标：CD4⁺、CD8⁺,计算CD4⁺/CD8⁺。手术前后采用生活健康量表简表（SF-36）评价患者生活质量。分析经尿道输尿管镜钬激光碎石术后尿路感染的影响因素。结果：150例患者中,术后有18例发生尿路感染,发生率为12.00%（18/150）。根据是否发生尿路感染分为感染组（n=18）和未感染组（n=132）。单因素分析结果显示,经尿道输尿管镜钬激光碎石术后尿路感染与结石直径、年龄、合并糖尿病、住院时间、预防性应用抗菌药物、结石残留情况、手术时间、双J管留置时间有关（P<0.05）。多因素Logistic回归分析结果显示：年龄为61~岁、结石直径≧2 cm、手术时间≧2 h、合并糖尿病、双J管留置时间≧14 d、有结石残留是术后发生尿路感染的危险因素,而预防性应用抗菌药物是其保护因素（P<0.05）。两组术后CD4⁺、CD4⁺/CD8⁺下降,但未感染组高于感染组;CD8⁺升高,但未感染组低于感染组（P<0.05）。两组术后精神健康、总体健康、社会功能、情感职能、活力、躯体疼痛、生理职能、生理功能评分均升高,且未感染组高于感染组（P<0.05）。结论：经尿道输尿管镜钬激光碎石术后尿路感染患者细胞免疫功能下降,生活质量降低,且其尿路感染受年龄、结石直径、手术时间等因素影响,预防性应用抗菌药物可降低尿路感染的发生风险。     

应用管路封堵器处理输尿管上段结石的随机对照研究

目的:研究辅助使用管路封堵器后,采用输尿管镜下碎石术处理输尿管上段结石的效果及安全性。方法:选取自2012年6月至2013年2月需输尿管镜处理输尿管上段结石的病例198例,随机分为应用管路封堵器组98例和对照组100例。封堵器组术中输尿管镜发现结石后,封堵器组患者使用英诺伟IVX-SC10型管路封堵器超越结石远端封堵结石,再予钬激光碎石,对照组术中输尿管镜发现结石后,直接予钬激光碎石,术后留置双J管2至4周。记录并随访患者输尿管镜术后结石清除率及肾脏出血相关并发症。结果:管路封堵器组碎石成功率95.9%(94/98),对照组碎石成功率81.0%(81/100),两组有统计学差异(P=0.0011)。碎石成功后管路封堵器组出现3例(3.2%)肾脏破裂出血,而对照组无肾脏破裂出血,两组无统计学差异(P=0.1048)。结论:辅助应用管路封堵器能提高输尿管镜对于输尿管上段结石的碎石成功率;其使用并没有增加术后肾脏出血并发症的发生。     

VCTDSA联合CT 灌乌司他丁联合硝苯地平控释片对ESWL 术后肾功能的保护作用

目的：观察乌司他丁(商品名天普洛安)和硝苯地平控释片(商品名拜新同)对体外冲击波碎石术(ESWL)所致急性肾功能损害 的保护作用。方法：将80 例接受ESWL治疗的肾结石患者,随机分为天普洛安组、拜新同组、天普洛安和拜新同联合组以及对照 组,每组20 例。检测并比较ESWL 前1 d 和后1、3、5 d 患者尿丙二醛(MDA)、N- 乙酰-beta-D- 氨基葡萄糖苷酶/ 肌酐(NAG/Cr)和 24 h尿beta2-微球蛋白(beta2-MG)的变化。结果：EWSL术后第1 天,对照组MDA、NAG/Cr和茁2-MG 水平均明显高于术前(P＜0.05), 且随着术后时间的延长,患者MDA、NAG/Cr 和beta2-MG 水平呈逐渐下降趋势,术后第1、3、5 天治疗组MDA、NAG/Cr 和beta2-MG 数值均明显低于相同时点对照组(P＜0. 05)。术后第1、3 天,联合用药组MDA、NAG/Cr和beta2-MG 水平明显低于单独用药的两组 (乌司他丁组和拜新同组)(P＜0.05),第5 天联合用药组MDA、NAG/Cr 和beta2-MG 水平与单独用药的两组(乌司他丁组和拜新同 组)比较均无明显差异(P＞0.05),单独用药的两组(乌司他丁组和拜新同组)之间在相同时点MDA、NAG/Cr 和beta2-MG 水平无明显 差异。结论：乌司他丁可显著减轻ESWL所致的肾损伤,与钙离子拮抗剂联合用药效果更佳。     

The effect of shock wave lithotripsy on nitric oxide and malondialdehyde levels in plasma and urine samples

Shock wave lithotripsy (SWL) is accepted as the first treatment choice for most urinary stones, but it has adverse effects on the kidneys. The mechanisms underlying shock wave-induced renal injury have been discussed and include shear stress, thermal and cavitation effects and free radical formation. We investigated the effects of SWL on plasma and urinary nitrite, a stable metabolite of nitric oxide (NO), and malondialdehyde (MDA) concentrations. Between February and October 2004, 12 men and 8 women with renal calculi were treated using a Dornier MPL-9000 lithotriptor. The ages ranged from 22 to 45 years (average age: 33.7 years). Plasma and urinary NO and MDA levels were analysed before, immediately after, 30 and 60 min and 24 h after SWL. Plasma NO levels were higher than baseline levels immediately, and at 30, 60 min and 24 h after treatment (p = 0.016, p = 0.031, p = 0.033 and p = 0.045, respectively). Simultaneously, the mean urinary NO levels also showed significant elevation after SWL compared with baseline values, except for 24 h (p = 0.021, p = 0.023 and p = 0.048, respectively). The mean levels of plasma MDA showed statistically significant elevation immediately, and 30 and 60 min after SWL termination compared with pre-SWL values (p = 0.012, p = 0.008 and p = 0.012, respectively). Urinary MDA levels obtained immediately (p = 0.035), and 30 (p = 0.006) and 60 (p = 0.045) min after SWL were increased compared to pre-SWL values. We speculate that SWL treatment causes oxidative stress caused by renal ischemia-reperfusion (I/R) injury. Additionally, the increase of NO production may have prevented renal damage caused by vasoconstriction.     

输尿管镜下钬激光碎石与体外冲击波碎石术治疗输尿管结石的比较研究

目的:研究输尿管镜下钬激光碎石与体外冲击波碎石术治疗输尿管结石的效果。方法:选取2013年1月到2015年1月我院收治的输尿管结石患者100例,根据手术方法不同将患者分为A组(n=56例,直径≥1 cm者23例,直径1 cm者33例)和B组(n=44例,直径≥1 cm者17例,直径1 cm者27例),其中A组给予输尿管镜下钬激光碎石治疗,B组给予体外冲击波碎石术治疗,比较两组手术时间、结石排净、术后并发症。结果:A组直径≥1 cm和1 cm者手术时间为(55.9±1.6)min和(38.9±0.7)min显著低于B组的(72.8±1.4)min和(53.6±0.7)min(P0.05);A组直径≥1 cm者结石排净率为87%显著高于B组的58.8%(P0.05),A组直径1 cm者90.9%与B组88.9%相近(P0.05);两组并发症发生率比较差异无统计学意义(P0.05)。结论:输尿管镜下钬激光碎石相比体外冲击波碎石术治疗输尿管结石手术时间短,对于直径≥1 cm者效果较好。     

The effects of extracorporeal shock wave lithotripsy on antioxidant enzymes in erythrocytes

The effects of extracorporeal shock wave lithotripsy (ESWL) on patients undergoing ESWL for renal stone treatment have been studied using activities of glucose-6-phosphate dehydrogenase (G6PDH), superoxide dismutase (SOD) and catalase (CAT), and levels of malondialdehyde (MDA) in the erythrocyte haemolysate. The study included 23 patients (eight women, 15 men with an age range of 23-57 years). Blood samples were taken 5 min before ESWL, in addition to 1 h and 5 days after termination of treatment. Enzyme activities and MDA levels in erythrocytes were measured spectrophotometrically. When compared with the values obtained before ESWL, erythrocyte G6PDH (p = 0.015), SOD (p = 0.036) and CAT (p = 0.01) activities were found to be significantly reduced at the first hour after ESWL. On the fifth day after ESWL, erythrocyte enzyme activities were normalized to the values obtained before ESWL. Although there was a significant difference between values before and 1 h after ESWL (p = 0.003), no difference was detected between 1 h after ESWL and 5 days after ESWL (p > 0.05) in terms of MDA values. The findings of the present study revealed that erythrocyte lipid peroxidation might be induced and antioxidative defence mechanism may be transiently impaired by ESWL.     

坦洛新对输尿管下段结石患者体外冲击波碎石术后排石及血清IL-6，IL-10和CRP水平的影响

目的:探讨输尿管下段结石行体外冲击波碎石术(ESWL)后应用坦洛新辅助排石的临床效果及对患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)水平的影响。方法:选取我院2015年1月～2016年12月收治的122例输尿管下段结石患者,采用随机数字表法均分为两组。于ESWL术后,对照组给予硝苯地平治疗,观察组予以坦洛新治疗。记录比较两组术后排石效果、疼痛情况,治疗前后血清IL-6、IL-10和CRP水平的变化及不良反应的发生情况。结果:治疗后,观察组无石率(91.8%)明显高于对照组(78.7%)(P0.05);观察组排石时间短于对照组,排石直径大于对照组(P0.05);观察组患者血清IL-6,IL-10及CRP水平均显著低于对照组(P0.05)。与对照组相比,观察组肾绞痛发生率、镇痛剂使用率及VAS评分均较低(P0.01)。用药期间,两组均未发生明显不良反应(P0.05)。结论:坦洛新能有效提高输尿管下段结石患者体外冲击波碎石术的排石效果,减轻机体损伤,缓解术后疼痛,并且安全性较高。