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Endoscopic surgery has become the most common urological procedure for calculus in upper urinary tract. However, the widespread usage of minimally invasive endoscopic techniques failed to end the occurrence of perioperative complications, especially some fatal complications. The most severe complication of urolithiasis related endoscopic procedure is urosepsis, which is closely related to the backflow of irrigation fluid induced by the high pressure of renal pelvic during the procedure. By controlling the perfusion and drainage during the operation, the liquid backflow can be reduced effectively, thus may reduce the spread of infectious toxins and pathogens, and incidence of infectious complications can be controlled accordingly. In this article, the pathophysiology of urinary obstruction, the backflow which caused by elevated renal pelvic pressure and its subsequent pathophysiological changes, the control of intra-renal gressure and the prevention of urosepsis will be reviewed. The important range of intra-renal pressure and the major steps for pressure control during the operation is emphasized.

Over the past few years, the prevalence of urinary stones has been gradually increasing, which imposes heavy burden of diseases on medical systems and people's health worldwide. Fortunately, a series of innovations in clinical management of urolithiasis have increased our response capacity to urinary stones. This article summarizes recent original innovations, performance optimization, and collaborative progress in the fields of diagnosis, pharmacotherapy, and surgical procedures of urinary stones. These innovations and corresponding application in clinical setting have the potential to facilitate the clinical management of urolithiasis and protect people from urolithiasis-associated injuries.

Objective: To assess the safety and efficacy of percutaneous nephrolithotomy (PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in the pediatric age group., Methods: Twenty-two renal units in 15 patients underwent PCNL at our institute. The patients were all under 14 years old. The average age was 9 years (range 5-14 years). There were 7 bilateral, 8 multiple, and 5 staghorn calculi. The average calculus size was 2.0 (0.9-4.5) cm. The PCNL was done with an X ray-guided peripheral puncture, a planned staged approach in some cases, and minimal tract dilatation with the use of an ureteroscope and pneumatic intracorporeal lithotripsy., Results: Complete stone clearance was achieved in 20 renal units, giving an overall clearance rate of 91%. Minor pyrexia (< 39 degrees C, < 2 days) was seen in 14 patients, whereas serious pyrexia was seen in 1. The average fall in hemoglobin was 10 g/L, but none of the patients required blood transfusion., Conclusions: It is safe and effective to cure pediatric urolithiasis with percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal and pneumatic intracorporeal lithotripsy.