Objective  To investigate the curative effect of head-down incline in holmium laser ureterscopic lithotripsy for upper ureteral calculi. 

Methods Clinical data was collected of patients who were diagnosed upper ureteral calculiand treated with holmium laser ureterscopic lithotripsyin head-down inclined position from April 2016 to December 2019. The effect of holmium laser ureterscopic lithotripsy in patients with upper ureteral calculi was evaluated. 

Results  Finally 246 patients with upper ureteral calculi treated with ureteroscope holmium laser lithotripsy were included. Of them, 98 cases of intraoperative stones moved up into the renal pelvis or upper group of calyces, ureteroscope was chased to the renal pelvis or upper group of calyces, and the stones were smashed with laser. 240 patients had primary crushed stones with a success rate of 97.6%. 4 patients with upper ureteral stenosis were successfully treated with ureteroscopic holmium laser lithotripsy after indwelling the DJ tube for two weeks. In one patient, some of the stones moved upward into the medial renal calyx of the middle group, and the extracorporeal shock wave lithotripsy was successful in the later stage. One patient's stones moved up into the upper group of calyces, and the stone fragments were about 0.6 cm. Twenty-six patients with bilateral ureteral calculi were successfully treated with bilateral ureteral holmium laser lithotripsy at the same time. The operation time was 15-56 min, with an average of 26.08±11.73 min; the length of hospitalization is 4-6 days. 

Conclusion The head-down inclined position is safe and effective in the treatment of upper ureteral calculi byholmium laser ureterscopic lithotripsy, and the success rate of first-stage lithotripsy is high. However, we suggest performing high quality controlled studies to verify.

 1. 王施广, 王娟, 王振, 等. 泌尿系结石的流行病学研究进展[J]. 现代生物医学进展, 2016, 16(3): 597-600, 592. DOI: 10.13241/j.cnki.pmb.2016.03.052. [Wang SG, Wang J, Wang Z, et al. Urolithiasis and Epidemiology: An Update[J]. Progress in Modern Biomedicine, 2016, 16(3): 597-600, 592.]

2. Constantinescu MA, Lee SL, Ernst S, et al. Probabilistic guidance for catheter tip motion in cardiac ablation procedures[J]. Med Image Anal, 2018, 47(1): 1-14. DOI: 10.1016/j.media.2018.03.008.

3. Cimino S, Favilla V, Russo GI, et al. Pneumatic lithotripsy versus holmium:YAG laser lithotripsy for the treatment of single ureteral stones: a prospective, single-blinded study[J]. UrolInt, 2014, 92(4): 468-472. DOI: 10.1159/000355828.

4. Chow G, Blute M, Patterson D.E, et al. Ureteroscopy: Update on current practice and long term complications[J]. Urol, 2001, 165(2): 71.

5. Knispel HH, Klän R, Heicappell R, et al. Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients[J]. J Endourol, 1998, 12(6): 513-515. DOI: 10.1089/end.1998.12.513.

6. 董圣芳,杨建勋,吕光耀,等.组合式输尿管软镜钬激光碎石术治疗肾和输尿管上段结石的疗效分析[J].国际泌尿系统杂志, 2017, 37(3): 368-371. DOI: 10.3760/cma.j.issn.1673-4416.2017.03.015. [Dong SF, Yang SF, Lyu GY, et al. Effect of combined treatment of renal and upper ureteral calculi with holmium laser lithotripsy[J]. International Journal of Urology and Nephrology, 2017, 37(3): 368-371.]

7. 程永毅. 输尿管软镜是否可以反复用于治疗大的肾结石?[J]. 现代泌尿外科杂志, 2015, 20(10): 745-748. DOI: 10.3969/j.issn.1009-8291.2015.010.017. [Cheng YY. Can flexible ureteroscopy be performed repeatedly to treat large renal calculi?[J]. Journal of Modern Urology, 2015, 20(10): 745-748.]

8. 那彦群, 叶章群, 孙颖浩, 等. 2014版中国泌尿外科疾病诊断治疗指南[M]. 北京：人民卫生出版社, 2014. [Na YQ, Ye ZQ, Sun YH, et al. Guidelines for Diagnosis and Treatment of Urological Diseases in China 2014[M]. Beijing: People’s Medical Publishing House, 2014.]

9. Hendlin K, Weiland D, Monga M. Impact of irrigation systems on stone migration[J]. J Endourol, 2008, 22(3): 453-458. DOI: 10.1089/end.2007.0260.

10.    冯华国, 谢衡生, 周乐友, 等. 改良侧卧位与截石位在输尿管镜下钬激光治疗输尿管上段结石中应用的比较[J]. 医学临床研究, 2006, 23(9): 1430-1432. DOI: 10.3969/j.issn.1671-7171.2006.09.033. [Feng GH, Xie HS, Zhou LY, et al. Comparison of Improved Flank Position with Lithotomy Position in Holmium Laser Lithotripsy Through Ureteroscope for Upper UreteralCalculi[J]. Journal of Clinical Research, 2006, 23(9): 1430-1432.]

11.    Mirabile G, Phillips CK, Edelstein A, et al. Evaluation of a novel temperature-sensitive polymer for temporary ureteral occlusion[J]. J Endourol, 2008, 22(10): 2357-2359. DOI: 10.1089/end.2008.0029.

12.    周高峰, 章传华, 吴维, 等. 输尿管镜钬激光碎石术治疗输尿管上段结石手术中是否联合应用NTrap网篮的疗效比较[J]. 中国内镜杂志, 2013, 19(6): 621-623.DOI: CNKI:SUN:ZGNJ.0.2013-06-017. [A comparison of ureteroscopy and holmium: YAG laser whether or not combined with NTrap basket for treatment upper ureteral calculi[J]. China Journal of Endoscopy, 2013, 19(6): 621-623.]

13. Pardalidis NP, Papatsoris AG, Kosmaoglou EV. Prevention of retrograde calculus migration with the Stone Cone[J]. Urol Res, 2005, 33(1): 61-64. DOI: 10.1007/s00240-004-0453-3.

14. 彭东毅, 黄凯, 尹光明, 等. 输尿管镜联合结石封堵导管与经微创皮肾镜治疗输尿管上段结石疗效比较[J]. 中国内镜杂志, 2014, 20(12): 1334-1336. [Peng DY, Huang K, Yin GM, et al. Comparison of curative effect of ureteroscopy combined with stone occlusion catheter and percutaneous nephroscopy in treatment of upper ureteral stones[J]. Chinese Journal of Endoscopy, 2014, 20(12): 1334-1336.]

15.    Lee YH, Tsai JY, Jiaan BP, et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones[J]. Urology, 2006, 67(3): 480-484. DOI: 10.1016/j.urology.2005.09.067.

16.    Mugiya S, Ozono S, Nagata M, et al. Retrograde endoscopic management of ureteral stones more than 2 cm in size[J]. Urology, 2006, 67(6): 1164-1168. DOI: 10.1016/j.urology.2006.01.088.

17.    DellAL, Papa S. Ten-year experience in the management of distal ureteral stones greater than 10 mm in size[J]. G Chir, 2016, 37(1): 27-30. DOI: 10.11138/gchir/ 2016.37.1.027.