Ultrasound-guided visualization puncture equipment clinical application of flexible ureteroscope in the treatment of lower calyx stones

Objective To explore the feasibility and safety of visualization puncture combined with flexible ureteroscopy in the treatment of lower calyx stones. Method Visualization puncture combined with flexible ureteroscopy to treat the lower calyx stones was done in our center from January to August 2016 in our hospital. 32 cases of patients were enrolled to have a retrospective analysis. There were 18 males and 14 females, aged from 25 to 65 years, with an average age of 43 years. The diameter of stone was 1.0-2.0 cm, with an average of (1.4±0.6) cm. We used general anesthesia and then adjusted the surgery bed to operation side lateral elevation was 30 °-35 °. Flexible ureteroscopy with 200μm holmium laser was used firstly to break calculi as much as possible.Ultrasound-guided F4.8 visualization puncture system was used to establish F4.8 channel. The power option was 200μm holmium laser to crush calculus of the renal calculi to treat the calculus of the distal end of soft lens which still can not be touched by ureteroscopy.Routine nephrostomy tube was not placed.The soft ureter sheath F5 double-J tube, and indwelling balloon catheter were routinely placed. We removed the catheter after 1-2 days and the double J tube after 4 to 6 weeks. Results The flexible ureteroscopy lithotripsy operation time was 8-25 mins in all of the 32 patients. Visualization puncture channels were successfully established in 3-7 mins, and the visualized puncture stone search rate of 100% (32/32). The success rate of first stage lithotripsy was 93.8% (30/32). Two cases of lower calyx stones diverticulum diverted to PNCL due to poor visibility by bleeding. The operation time was 30-60 mins and the average of 45 mins. KUB review at day one after the surgery showed that there were residual stones in 5 cases. The stone free rate at one month after the surgery is 100.0%.The average postoperative hospital stay was (2.0±1.5) days. There were no bleeding, ureteral avulsion and perforation, septic shock, pleural effusion and intestinal injury and other serious complications. Conclusions Navigation ultrasound-guided visualization puncture combined with flexible ureteroscopy is safe and effective to treat lower calyx stones. Key words: Visualization puncture; Flexible ureteroscopy; Ultrasound-guided; Lower calyx stones