肾脏和泌尿道受到多种疾病的影响 — from the common (kidney stones and urinary tract infections) to the complex (chronic kidney disease, hydronephrosis, and ureteral strictures). 有效管理日益依赖于微创内尿道手术，包括柔性输尿管镜检查（fURS/RIRS）、经皮肾镇痛术（PCNL）和球囊扩张。本指南涵盖与泌尿外科实践最相关的解剖学、疾病和手术 — and links to the single-use instruments used at each step.
肾脏和泌尿道的解剖学
肾上腺
位于肾脏上方。产生包括皮质醇和醛固酮在内的激素, which influence kidney function and blood pressure.
肾脏
豆形器官（约11厘米长），位于腹膜后。每个包含约100万个肾单位 — the functional filtration units.
肾盂与输尿管
肾盂从肾盏收集尿液；输尿管（25-30厘米）通过蠕动将其运输到膀胱.
膀胱和尿道
膀胱可储存约500毫升尿液。尿道将其输送到体外；长度可变（女性约4厘米，男性约20厘米）.
Clinically Relevant Microanatomy
- • Nephron: Composed of the glomerulus, proximal tubule, loop of Henle, distal tubule, and collecting duct. Proximal tubule responsible for ~67% of solute/water reabsorption; primary target of ischaemic AKI.
- • Juxtaglomerular apparatus (JGA): Macula densa senses tubular sodium and regulates renin secretion — central to blood pressure homeostasis and the RAAS axis.
- • 输尿管o-vesical junction (UVJ): Acts as a physiological valve preventing reflux; most common site for stone impaction. 输尿管oscopy access through the UVJ may require balloon or active dilation.
- • Pelvi-ureteric junction (PUJ): Second most frequent stone impaction site; PUJ obstruction often requires endopyelotomy or pyeloplasty.
肾脏功能
The kidneys are remarkable multi-functional organs. Far more than simple filters, they regulate the entire fluid balance of the body and produce vital hormones.
过滤
从血液中去除尿素、肌酐、药物和废物——每分钟过滤约125毫升（GFR）
液体与电解质平衡
通过精确的肾小管重吸收调节钠、钾、钙、磷酸盐和水平衡
激素
产生促红细胞生成素（EPO）、激活维生素D并释放肾素 — critical for blood pressure and red cell production
基于GFR的CKD分期（KDIGO 2024）
* Albuminuria category (A1–A3) must always be combined with GFR staging for prognosis. KDIGO 2024 emphasises heat map risk stratification.
肾结石 (Nephrolithiasis)
Kidney stones are hard mineral deposits that form inside the kidneys when urine becomes concentrated. They vary in size from a grain of sand to several centimetres. 小结石可能会自行排出；较大的可能需要医疗干预.
Types of 肾结石
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草酸钙
最常见（80%）。与低液体摄入和高草酸饮食相关
🔴
尿酸
约10%。与痛风、高蛋白饮食、脱水相关
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磷酸铵镁
约10%。由尿素酶产生菌引起；可形成大的鹿角形结石
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半胱氨酸
Rare (<1%). Genetic disorder causing excess cystine excretion
Symptoms of 肾结石
| 结石大小 | 位置 | 首选治疗（EAU 2024） | 器械 |
|---|---|---|---|
| <4 mm | 输尿管 / Renal | 观察等待 / MET（α-阻滞剂或钙通道阻滞剂） | — |
| 4–10 mm | Distal ureter | SWL或半硬性URS | UAS (e.g. Manawa FANS), laser fibre |
| 10–20 mm | Renal pelvis / calyx | SWL或柔性URS（fURS / RIRS） | UAS with suction; single-use scope |
| >20 mm | Renal | PCNL（标准或微创） | Nephrostomy balloon dilator (e.g. Tahina); nephrostomy access sheath |
| Staghorn | Complete renal pelvis | PCNL ± 分期 SWL | Large bore nephrostomy sheath; suction drainage |
Metabolic Workup Indications
24-hour urine collection (calcium, oxalate, citrate, uric acid, sodium, creatinine, volume) indicated for: recurrent stone formers, bilateral or multiple stones, children, family history, solitary kidney, or first-time stone in patient with CKD. Serum workup: calcium, PTH, uric acid, bicarbonate.
梗阻与肾积水
肾积水是由于尿液积聚导致的一个或两个肾脏肿胀. This usually occurs because a blockage prevents urine from draining properly. Causes include kidney stones, strictures, enlarged prostate, or tumours.
如果不及时治疗，梗阻可导致永久肾脏损害. Treatment depends on the cause and severity — ranging from ureteral stents to surgical correction.
| 分级 | 超声检查发现 | 临床意义 |
|---|---|---|
| 分级 I | 仅轻度肾盂扩张 | 通常是生理性的；观察 |
| 分级 II | 肾盂 + 主肾盏扩张 | 调查梗阻原因 |
| 分级 III | 所有肾盏扩张；皮质保留 | 可能需要干预 |
| 分级 IV | Cortical thinning (<2 mm) | 紧急引流；长期功能风险 |
⚠️ 梗阻感染肾脏 — Urological Emergency
梗阻性化脓性肾积水（梗阻近端感染）如果延迟引流会导致20-40%的死亡率 if drainage is delayed. 紧急减压经皮肾造口或逆行输尿管支架置入必须在确定性结石治疗之前进行. 单独的抗生素治疗是不够的——引流是强制性的. 不应在感染、梗阻的系统上进行选择性输尿管镜检查.
慢性肾脏病 (CKD)
CKD is a gradual loss of kidney function over months or years. It is often silent in early stages but can progress to kidney failure requiring dialysis or transplantation. The most common causes are diabetes and high blood pressure.
Common Causes
- • 糖尿病 mellitus (T1 & T2)
- • Hypertension
- • 肾小球肾炎
- • 囊性肾病
- • Recurrent obstructive uropathy
- • Chronic NSAID use
Warning Signs
- • Fatigue & weakness
- • Swollen ankles/legs (oedema)
- • Shortness of breath
- • Nausea / poor appetite
- • Foamy or dark urine
- • Persistent itching (pruritis)
Management Goals
- • BP control (<130/80 mmHg)
- • Glycaemic optimisation
- • RAAS blockade (ACEi/ARB)
- • SGLT2 inhibitors (CKD + T2DM)
- • Low-protein diet (G4–G5)
- • Nephrology referral
CKD & Urological Intervention — Practical Considerations
- • Contrast-induced nephropathy risk: use iso-osmolar contrast; pre-hydration; consider CO2 urography in eGFR <30 mL/min/1.73m².
- • Nephrotoxic antibiotics (aminoglycosides, vancomycin) require dose adjustment; use with caution in eGFR <60.
- • Stone disease accelerates CKD progression — complete clearance and metabolic prevention are priority.
- • PCNL in solitary kidneys: suction drainage sheaths are preferred to minimise pyelovenous backflow and post-operative sepsis risk.
- • JJ stent dwell time: avoid >3 months; encrustation risk dramatically elevated in hyperoxaluria, hypercalciuria, and infection.
输尿管狭窄
A ureteral stricture is a narrowing of the ureter that can impede normal urine flow from the kidney to the bladder. It may cause pain, recurrent infections, or kidney damage if untreated.
Common Causes
- • Prior urological procedures (ureteroscopy, stone treatment)
- • 放射线治疗 to the pelvis or abdomen
- • Retroperitoneal fibrosis
- • Ischaemia (post-transplant, vascular)
- • Tumour compression or invasion
- • 先天性 (PUJ obstruction)
Treatment Options
- • Balloon dilation: First-line for short, non-ischaemic strictures — using high-pressure ureteral balloon dilators
- • Endoureterotomy: Laser or cold-knife incision
- • JJ stenting: Temporary or long-term urinary diversion
- • Open / laparoscopic repair: 输尿管oureterostomy, Boari flap, psoas hitch, ileal interposition for complex/long strictures
- • 输尿管al reimplantation: For distal strictures
Balloon Dilation — Clinical Context
High-pressure balloon dilation (up to 20 ATM) with non-compliant balloon catheters (e.g. Tahina 输尿管al) allows radially uniform force delivery across a stricture. Success rates of 50–80% in short (<1 cm), non-ischaemic, non-radiation-induced strictures. Ischaemic and radiation-induced strictures have higher recurrence rates (>50%); endoscopic balloon dilation serves as temporisation or repeated palliation in these cases. Kink-resistant shaft and hydrophilic distal coating are essential properties for negotiating tortuous ureters and tight strictures.
Urological Procedures: 输尿管oscopy, PCNL & Minimally Invasive Treatments
When medication and watchful waiting are not enough, various minimally invasive procedures can treat kidney and urinary tract conditions safely and effectively. Here's a plain-language overview of the most common ones.
输尿管oscopy (URS / fURS)
A thin flexible or semi-rigid scope is passed through the urethra and bladder into the ureter or kidney. Stones can be fragmented with a laser and removed, or biopsies taken.
Flexible URS (RIRS) preferred for renal calculi >10 mm. 输尿管al Access Sheaths (UAS) maintain access, reduce intrarenal pressure, and improve stone clearance. Active suction UAS (Manawa FANS) further reduces pyelovenous backflow and post-procedural sepsis. Single-use flexible ureteroscopes eliminate cross-contamination risk and maintain consistent optical performance.
经皮肾镇痛术（PCNL）
A small incision is made in the back to create a direct tract into the kidney. A nephroscope removes large or complex stones. Standard PCNL (24–30 Fr), Mini-PCNL (14–20 Fr), Micro-PCNL (<14 Fr).
Tract dilation is accomplished using nephrostomy balloon dilators (e.g. Tahina Nephrostomy, 24Ch/30Ch, 17 ATM rated burst) or sequential fascial dilators. Balloon dilation is faster and associated with less blood loss vs. sequential. Suction nephrostomy access sheaths (Manawa Nephrostomy) reduce calyceal fluid distension, stone fragment migration, and systemic absorption of irrigation fluid — particularly valuable in renal insufficiency or complex staghorn stones.
Shock Wave Lithotripsy (SWL)
Non-invasive procedure using focused sound waves to break kidney stones into small fragments. Best for stones <10–15 mm in the renal pelvis or upper ureter.
输尿管al Stenting & Nephrostomy Drainage
A JJ (double-J) stent is placed inside the ureter to maintain drainage. A nephrostomy tube provides external kidney drainage when a retrograde approach is not possible (e.g. in obstruction with infection).
Nephrostomy access is guided by fluoroscopy or ultrasound; tract established by serial dilation or balloon dilation over a guidewire. Balloon dilators with radiopaque markers (e.g. Tahina Nephrostomy) enable real-time fluoroscopic confirmation of position. Post-PCNL nephrostomy tubes maintain tract patency for potential second-look procedures.
Frequently Asked Questions: Kidney & Urinary Tract
What causes kidney stones and how are they treated?
Kidney stones (nephrolithiasis) form when urine is concentrated with calcium, oxalate, uric acid, or other minerals. The most common type is calcium oxalate (~80%). Small stones under 4 mm often pass naturally. Stones 4–20 mm are treated with shock wave lithotripsy (SWL) or flexible ureteroscopy (RIRS) using a ureteral access sheath. Stones over 20 mm typically require percutaneous nephrolithotomy (PCNL).
What is flexible ureteroscopy (RIRS) and when is it recommended?
Flexible ureteroscopy (fURS), also called Retrograde Intra-Renal Surgery (RIRS), passes a thin flexible camera through the urethra and bladder into the kidney. It is recommended for renal stones over 10 mm. A ureteral access sheath (UAS) is placed inside the ureter to maintain instrument access, reduce intrarenal pressure, and improve stone clearance.
What is PCNL (percutaneous nephrolithotomy)?
Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for large kidney stones over 20 mm or staghorn calculi. A small incision in the back creates a tract directly into the kidney, dilated using a nephrostomy balloon dilator. A nephroscope then fragments and removes the stones under direct vision. Suction access sheaths help reduce intrarenal pressure and post-operative infection risk.
What is hydronephrosis and how is it treated?
Hydronephrosis is swelling of one or both kidneys caused by blocked urine flow. 常见原因 include kidney stones, ureteral strictures, or tumours. 轻度 cases (分级 I–II) may be monitored. 严重 cases (分级 III–IV) require urgent drainage via ureteral stenting or percutaneous nephrostomy to prevent permanent kidney damage.
What is a ureteral access sheath?
A ureteral access sheath (UAS) is a thin dual-lumen tube inserted into the ureter to provide continuous access during flexible ureteroscopy. It reduces intrarenal pressure, improves irrigation outflow, and enables repeated instrument passes. Suction-enabled access sheaths (such as the Manawa FANS) actively evacuate stone fragments and irrigation fluid, reducing post-procedural infection risk and improving operative field clarity.