NO.1 Case introduction

Patient Yu XX gender female age 68 years old

He was admitted to hospital with 'intermittent pain in the right waist for more than 6 months, aggravated for 5 days' as the chief complaint.

Preoperative diagnosis: 1 kidney stone (right side), 2 urinary tract infection

Color ultrasound showed that there were several strong echoes in the collecting system of the right kidney, the larger one was about 2.5cmx1.0cm; Calculi in the middle and lower calices of the right kidney were found on CT with a CT value of 1100HU

Preoperative abnormal test results Urine routine 580.00 red blood cells /ul and 10.00 white blood cells /ul.

Preoperative CT image

Difficulty in operation The calculi are located in the middle and lower calices, with a large stone load and a length of 2.5cm. If flexible ureteral lithotripsy is taken, the operation time will be longer, and it is difficult to remove the calculi at one time, so it may be necessary to perform multiple operations. If percutaneous nephrolithotomy is taken, the difficulty of puncture will increase and the probability of bleeding will increase due to the absence of hydronephrocalyces.

NO.2 Operation procedure

Surgical record

① After successful anesthesia, the patient was taken to the lithotomy position, and the skin in the operative area was disinfected and covered with sterile towel.

② The video fiber was inserted into the disposable visual ureteroscope sheath (Youkang) and into the bladder under the direct vision of the urethra. The bladder mucosa was observed to be normal, and the ureteral opening was symmetrical on both sides without deformity. The ureteroscope sheath was inserted into the right ureter to the lower margin of the ureteropelvus junction under the guidance of the zebra guide wire, and the inner core of the lens sheath was removed and the lens sheath was fixed. The patient was placed in prone position and the abdomen was raised. The skin in the operative area was disinfected and sterile towel was applied.

③ Calicium puncture was made into the right kidney near 12 ribs of the posterior axillary line with needle perc visual needle nephroscope under the guidance of B-ultrasound positioning, and the entry into the middle calicium was confirmed under direct vision of needle nephroscope. After successful implantation, multiple stones were found in the middle and lower calices of the kidney, yellow in color, with a maximum diameter of about 2.5cm. Holmium laser fiber was inserted into the fiber channel of needle nephroscope with an energy of 1.0J×20Hz. The stones were crushed under direct vision in the water injection channel, and the stone powder was discharged through the indwelling ureteroscope sheath. After the lithotripsy was completed, zebra guide wire was placed through the ureteroscope sheath, and double J tubes were placed, the ureteroscope sheath was withdrawn, and urinary tubes were indwelled.

Surgical picture

Surgical video

NO.3 Postoperative situation

The patient's vital signs were stable, painless and less traumatic. He was discharged 2 days after surgery.

Postoperative picture

Abdominal radiographs 24 hours after surgery showed that about 95% of the stones were cleared. Postoperative plain film is shown in the following figure:

NO.4 Surgical highlights

The combination of needle perc visual needle nephrolithotripsis and ureteroscope sheath for stone removal has the following advantages: 1. Needle perc visual needle nephrolithotripsis can achieve accurate puncture with less damage and no need to expand the channel; 2. 2. The indwelling ureteroscope sheath is conducive to the discharge of the water injected into the kidney during the lithotripsis process, thereby reducing the pressure in the kidney, and at the same time, the stone powder is rushed out through the water flow to play the role of stone extraction, which solves the limitation that only stone can be crushed when the needle perc visual needle nephrolithotripsis is used. This method can be used for lithotomy even if the stone load is large. The maximum length diameter of the stone in this case is 2.5cm, and the KUB plain film shows that 95% of the stones have been discharged 24 hours after the operation, achieving a good therapeutic effect.