Clinical study of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi

Objective To explore the feasibility and safety of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi. Methods The clinical data of 107 patients with renal calculi treated from January 2015 to October 2018 were analyzed retrospectively. Age ranged from 18 to 55 years, with mean of (32.1±5.2) years. Calculi was single, locating in the middle or upper calyx, with the diameter less than 2.0 cm, the CT value ≤800 HU, and mild renal hydronephrosis. All patients were routinely indwelling double-J tube using cystoscopy 2 weeks preoperatively, and ureteroscopic lithotripsy was performed. Fifty patients in group A were received tubeless treatment, and 57 patients in group B were given routinely indwelling double-J tube. The 50 patients in group A were (30.4±5.9) years of age, including 33 males and 17 females, 28 cases on the left and 22 cases on the right, 24 cases locating in the upper calyx and 26 cases locating in the middle calyx, and calculi diameter of (1.3±0.5) cm. The 57 patients in group B were (31.3±5.4) years of age, including 35 males and 22 females, 26 cases on the left and 31 cases on the right, 27 cases locating in the upper calyx and 30 cases locating in the middle calyx, and diameter of (1.4±0.4) cm. There were no significant difference in the demographics between the two groups (P>0.05). Results There were no obvious ureteral malformations, stenosis, polyps or tumors in the 107 cases intraoperatively, and the flexible ureteroscope sheath was placed smoothly. The operation time in group A [(48.2±9.7)min] was significantly lower than that in group B [(51.7±7.8)min, P 0.05), and the calculi clearance rate reached 100% at 1 month after operation. The incidence of hematuria in group A [24.0%(12/50)] was significantly lower than that in group B [54.4%(31/57), P=0.001]. The incidence of bladder irritative symptoms in group A [14.0%(7/50)] was significantly lower than that in group B [36.8%(21/57), P=0.007]. The incidence of lumbar and abdominal pain at 1 week, 2 weeks and 1 month after operation was significantly lower in group A [32.0%(16/50), 8.0%(4/50), 2.0%(1/50)] than that in group B [57.9%(33/57), 49.1%(28/57), 33.3%(19/57), P 0.05]. Conclusions It was feasibility and safety to perform flexible ureteroscope with tubeless for the patients with renal primary and single calculi, ideal ureteral conditions (no malformations, stenosis, polyps or tumors), mild renal hydronephrosis, calculi, diameter <2.0 cm, CT value ≤800 HU, locating in the middle or upper calyx, and no history of urinary calculi. This procedure had not only similar calculi clearance rate compared with routinely indwelling double-J tube, but also has a lower incidence of complications (hematuria, bladder irritative symptoms, lumbar or abdominal pain). Key words: Renal calculi; Flexible ureteroscope; Tubeless