AB094. Upper urinary stone management in China

Objective: To give an overview of the contemporary management for upper urinary stones in China.

Methods: Contemporary treatment methods, especially novel or developing modality with Chinese characteristics, for upper urinary stones in China has been reviewed and introduced.

Results: 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 a significant reduction of lower urinary stone and an increase of 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. The management of upper urinary stone can be challenging somehow. Extracorporeal shock wave lithotripsy (ESWL) is usually the first choice for patients with simple upper urinary stone sized 2 cm or less. 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 improves the stone-free rate. Percutaneous nephrolithotomy (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. However, its efficiency of removing stone fragments is lower. The Chinese urologists have modified PCNL technique by using an 8/9.8 F rigid ureteroscope through the 14-18 F percutaneous tract under the guidance of ultrasound or X-ray. The results from a series of studies demonstrate that Chinese mPCNL is a safe, feasible and efficient method for treating upper urinary stone with a low complication rate. With the development of technology, flexible ureteroscopy has become one of the main actors in clinical practice over the past several years. Flexible ureteroscopy can reach most 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 allows 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 PCNL. However, the flexible ureteroscopy is much more difficult to handle than the rigid ureteroscope. In addition, the flexible ureteroscope is expensive and easy to be damaged or broken, the treatment cost usually higher than ordinary treatment. In the past decades, some Chinese urologists and engineers have put in a great effort to design novel types of flexible ureteroscope which is cheaper and easier to operate. The integrated flexible and rigid ureteroscope is one of the new designed instruments of which the body is an ordinary rigid ureteroscope but have a flexible end. This novel device could be operated as easy as rigid ureteroscope and the end of ureteroscope could move flexiblely after its entry of the renal pelvis. Several different types of the Chinese flexible ureteroscope 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 and some novel treatment methods with Chinese characteristics has been developed. Each treatment method has advantages and disadvantages. The urologists’ 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; extracorporeal shock wave lithotripsy (ESWL); percutaneous nephrolithotomy (PCNL); flexible ureteroscopy; China