AB109. Upper urinary stone management in China

Objective: Urolithiasis is one of the most prevalent diseases in the urologic clinic and usually affects people aged 20 to 60 years. In recent years, the overall morbidity of urolithiasis in Chinese population has increased with significant reduction in patients with lower urinary stone and an increase in patients with upper urinary stone. Upper urinary stone may induce more severe complications and have been considered to be the main cause of nephrectomy besides urinary tumor.

Methods: The management of upper urinary stone may still challenging somehow. Extracorporeal shock wave lithotripsy (ESWL) usually is the first choice for the patients with simple upper urinary stone of 2 cm and down. Recent years, according to the mechanism of lithecbole by vibration and body position, some Chinese urologists have developed a novel machine, external physical vibration lithecbole (EPVL), which can facilitate removal of urinary stone after ESWL or endoscopic lithotripsy. The combination of EPVL therapy with ESWL or endoscopic lithotripsy significantly increases the stone-free rate. Percutaneous nephrostolithotomy (PCNL) is increasingly employed as a major modality for patients with large and complex upper urinary stone. The minimally invasive PCNL (mPCNL), which was performed with a miniature endoscope by way of a small size tract (12-20 F), could decrease morbidity, especially uncontrolled hemorrhage but have the disadvantages of low efficiency to remove stone fragment. The Chinese urologists have modified PCNL technique by using an 8/9.8 F rigid ureteroscope through the 14-18 F percutaneous tract under ultrasound or X-ray guidance. The results from a series of studies demonstrate that Chinese mPCNL is safe, feasible and efficient for treating upper urinary stone with a low complicate rate.

Results: With the development of techology, the flexible ureteroscope have become the main actors in clinical practice over the past several years. Flexible ureteroscopy allows entry into all parts of the kidney so that all stones can be removed or vaporised provided they are of an appropriate size and accessible. Moreover, flexible ureteroscopy is well tolerated and effective which allowed us to obtain a high success rate, low morbidity, and a brief hospital stay. It could be the best option in managing the special patients with multiple intrarenal stones, stone-bearing caliceal diverticula、anticoagulated history, obesity, anomalous kidneys and pregnancy, which are not applicable for ESWL or PCN. However, the flexible ureteroscope is much more difficult to handle than the rigid ureteroscope. In addition, the flexible ureteroscope is expensive and easy to damage or break, the treatment cost usually higher than ordinary treatment. In past decades, some Chinese urologists and engineers have put in a great effort to design novel types of flexible ureteroscope which more cheap and easy to operate. The integrated flexible and rigid uroteroscope is the one of the new designed instruments of which the body is the ordinary rigid ureteroscope but have a flexible end. This novel device could be operated as easy as rigid ureterosope and the end of uroteroscope could move flexible after it entry the renal pelvis. Several different types of the Chinese flexible uroteroscope have completed the clinical trials and are going to be commercially available.

Conclusions: Generally, Upper urinary stone is one of the most common diseases in urologic department in China. Each treatment has advantages and disadvantages. The urologist’s choice of the treatment strategy should be made individually according to the properties of stone and the patient’s body condition.

Keywords: Upper urinary stone; management; China