Effect of Ultrasound-guided Percutaneous Nephroscopic Holmium Laser Lithotripsy in the Treatment of Complex Renal and Ureteral Calculi and its Influence on the Degree of Trauma and Urinary Function
Zhao Dalong
Li Shouguo
Zhong Xiangyu
Abstract：Objective:To analyze the efficacy of ultrasound-guided percutaneous nephrolithotomy(PCNL)with holmium laser lithotripsy in treating patients with complex renal and ureteral calculi and to observe changes in trauma severity,urinary function,renal function,and stress response.Methods:A total of 120 patients with complex renal and ureteral calculi admitted to Lianyungang Municipal Dongfang Hospital from September 2021 to September 2023 were selected and randomly divided into a control group and an observation group using a random number table,with 60 patients in each group.The control group underwent ultrasound-guided standard-channel PCNL(sPCNL),while the observation group underwent ultrasound-guided mini-channel PCNL(mPCNL).Both groups were followed up for 3 months postoperatively.Clinical indicators,stone clearance rate,pain level[visual analog scale(VAS)],and complication rates were compared between the two groups.Additionally,urinary function before and after surgery,as well as trauma severity(renal function and stress response),were evaluated.Results:Compared with the control group,the observation group had a longer operation time,less intraoperative blood loss,shorter time to first ambula-tion and hospitalization,and a lower complication rate,with statistically significant differences(all P＜0.05).There were no significant differences in stone clearance rates immediately after surgery,at 1 month,or at 2 months postop-eratively between the two groups(all P＞0.05).Compared with the control group,the observation group had lower VAS scores on postoperative day 1,less residual urine volume at 1 week postoperatively,and higher maximum uri-nary flow rates,with statistically significant differences(all P＜0.001).The observation group had lower blood urea nitrogen(BUN)and serum creatinine(Scr)levels on postoperative day 1 than those in the control group,with statis-tically significant differences(both P＜0.05).The observation group had lower cortisol(Cor)and malondialdehyde(MDA)levels on postoperative day 1 than those in the control group,with statistically significant differences(both P＜0.05),while superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)levels were higher,with statistical-ly significant differences(both P＜0.05).Conclusion:Ultrasound-guided PCNL is effective in clearing stones in patients with complex renal and ureteral calculi.Compared with sPCNL,mPCNL is less traumatic,promotes faster postoperative recovery,alleviates pain,improves urinary function,reduces complications,and mitigates renal injury and stress response.The appropriate surgical approach can be selected based on patient needs.
Keywords：complicated renal ureteral calculiultrasound-guided percutaneous nephrolithotomy holmium laser litho-tripsyMinimally invasive surgical procedurestandard tracttrauma extenturinary function
Publication Date：2025-04-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 91-96 )