Application of plasma electrosurgery sheath combined with ureteroscopic pneumatic ballast in the treatment of bladder stones Wang Qinghong Department of Urology, Fushun Central Hospital Since April 2004-April 2012, we have used plasma electrosurgery sheath as a channel to protect the urethra while combining with nephroscopic pneumatic ballast lithotripsy. We treated 86 cases of bladder stones with satisfactory results, which are reported as follows Keywords: bladder stones, plasma electrosurgery sheath, nephroscopy, pneumatic ballistic lithotripsy, Fushun Central Hospital, Department of Urology, Wang Qinghong 1 Clinical data Among the 86 patients with bladder stones, 58 were male and 28 were female; their ages ranged from 22 to 75 years. All of them had urinary pain, difficulty in urination and urinary irritation symptoms, among which 19 cases had urinary retention due to stones embedded in the posterior urethra and 16 cases had bladder stones associated with prostatic hyperplasia. Except for the patients with prostatic hyperplasia, the preoperative examination did not show any organic obstructive lesions in the urethra, and the ultrasound and X-ray abdominal plain showed single or single bladder stones with diameters of 0.8-5 cm, and posterior urethral stones with diameters of 0.8-1.5 cm. The lithotripsy was performed in the lithotomy position, and double-block anesthesia was used in all cases. After routine disinfection and towel laying, the plasma electrosurgery sheath was placed first, and the sheath was kept as a channel, and then the nephroscope was used to speculate on the bladder, and the bladder was filled slightly with irrigation fluid to observe the stone number, size and shape. If the stone particles are large, they can be clamped out with a three-jawed forceps. In case of small sand grains. The bladder is repeatedly flushed out with the Elik flush to remove all the stones. The remaining small amount of small stones can be excreted during urination. In our group, 19 patients with posterior urethral stones were treated with a metal urethral probe to push the stones back into the bladder before undergoing microscopic lithotripsy. 16 patients with prostatic hyperplasia were treated with transurethral electrodesis of the prostate under continuous epidural anesthesia, and the lithotripsy was performed by exiting the electrodesis and inserting a lithotripter after completion of electrodesis. In 16 patients with prostatic hyperplasia, catheterization was left in place after surgery and the bladder was continuously flushed, and the urine color was normal after 4 to 6 days. The other 3 patients had more stones, longer operation time, and mucosal injury, with more obvious carnal hematuria, were given indwelling catheterization, applied hemostatic drugs, kept urine drainage unobstructed, and the carnal hematuria disappeared after 2 to 3 days, and urinated well on their own after removal of the urethra. The rest of the patients were not catheterized and were advised to drink more water and increase the urine volume, and the urine color turned normal 1 to 3 days after surgery. All 82 patients in this group had successful lithotripsy, and urinary pain and obstruction were relieved. 16 patients with prostatic hyperplasia had postoperative catheterization and continuous bladder irrigation, and their urine color became normal after 4-6 days. 3 patients with bladder hemorrhage had postoperative catheterization, bladder irrigation, and hemostatic drugs, and their urine was clear after 1 to 3 days, and they urinated well after catheter removal. All cases were followed up for 6 to 9 months with normal urination, no painful urination, interruption of urinary line and obstruction. Ultrasound and X-ray abdominal plain film were repeated, and the bladder or posterior urethral stones disappeared. 3 Discussion Transurethral nephrolithotomy is performed by lithotripter under the direct view of cystoscope. The method of lithotripsy is to use the plasma electrosurgical sheath as a channel. It is combined with pneumatic ballistic lithotripsy. The procedure is simple, with little damage, little bleeding, fast recovery, and precise efficacy, which can directly relieve the pain. For adult patients with bladder stones, except for organic obstruction of the urethra, which requires surgical correction and simultaneous stone extraction, bladder stones can basically be lithotripsy under the scope, replacing cystotomy for stone extraction. Bladder and posterior urethral stones can be taken regardless of their size. The limitation that mechanical lithotripsy cannot exceed 2cm is solved. Meanwhile, the plasma mirror sheath plays a role in protecting the mucosa of the urethra and favorably reduces the damage to the urethra. It plays a good role in the rapid recovery of patients. And the urethra without organic obstruction. In case of acute infection in the urinary tract, the infection needs to be controlled before lithotripsy, otherwise it is easy to cause the spread of infection. Although lithotripsy is easy to perform, it must be performed by a specialist skilled in cystoscopy. It is important to understand the condition in detail before surgery and to operate gently without violence to avoid damage to the bladder and urethra and even perforation. The bladder should be filled before lithotripsy to make the mucosal folds disappear so as not to entrap the bladder mucosa and cause bleeding. Since bladder stones are often accompanied by bladder mucosal congestion and edema, if the mucosa is inadvertently caught during lithotripsy or the rough surface of the stone pierces the mucosal vessels, there is a possibility of bladder bleeding. If the bleeding is small, a catheter should be left in the bladder to drain the bladder after lithotripsy is completed and the bladder should be flushed if necessary. If there is more bleeding, lithotripsy should be stopped immediately, the clot should be flushed, and the catheter should be kept in place to avoid serious complications from blind lithotripsy. However, all such events were reduced by adopting this approach. Therefore, it is worth promoting. [References] [1] Zhang X, Ye Zhanqun, Song X, et al. Comparison of the efficacy of cystoscopic lithotripsy (with 93 case reports) [J]. Chinese Journal of Urology, 2002, 23(6):332-334.[2] ZHANG X,LI HZ,WANG SG,et al. Retroperitoneal laparoscopic dismembered Pyeloplasty:experience of 50 cases[J].Urology,2005,66(3):514-517.[3] Smith CD,Weber CJ , Amerson Laparoscopic adrenalectomy:new gold standard[J].World J Surg ,1999,23(4):389-396. reposted from China paper download center http://www.studa.net