Retrograde intrarenal surgery for a staghorn renal calculus in a patient with solitary kidney and urinary tract deformity: a case report

Staghorn renal calculi are large, branched stones in the kidney that partially or completely fill the renal pelvis and renal calyces. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn calculi. However, we report a retrograde intrarenal surgery (RIRS) performed to treat a staghorn calculus in a patient with a solitary kidney and a deformed urinary tract. The 37-year-old male patient presented with right-sided lumbar pain. The computed tomography (CT) scan found a solitary kidney on the right side with an opaque 4.5 cm × 2.4 cm renal stone and grade I hydronephrosis. Additionally, a urinary tract deformity was observed, and it was secondary to the deformity of the pelvis caused by a previous pubis fracture, which significantly increased the risk and the difficulty of intrarenal surgery. A total number of 3 sessions of RIRS were conducted, and the patient was discharged 3 days after each session on average. The postoperative X-ray exam of the third session revealed that the renal stone was completely removed. The patient recovered well without any complications. This case demonstrates that RIRS is a safe and effective treatment of staghorn calculi with the presence of urinary tract deformation. This suggests RIRS may be of particular interest in minimizing the procedure-related damage of a solitary kidney.     

Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi

The aim of this work is to validate the clinical efficacy of the high-power holmium:YAG laser with percutaneous nephrolithotripsy (PCNL) in combination with ultrasound lithotripsy for complicated renal calculi. From November 2006 to December 2007, 60 patients with complicated renal calculi were treated with PCNL, where an F24 standard renal access tract was established by percutaneous renal puncture under the guidance of B-mode ultrasound, and stones were fragmented and cleared by high-power holmium laser in combination with ultrasound under an F20.8 nephroscope. Of the 60 patients with complicated renal calculi, 20 were complete staghorn calculi and 30 were partial staghorn calculi, of which six patients were accompanied with renal insufficiency; two were solitary calculi, and eight were caliceal diverticular calculi. Calculi were removed by one attempt in 49 patients and by two attempts in 11 patients; through one tract in 50 patients and through two and three tracts in ten patients. The stone-free rate was 81.7%. No injury to the pleura and abdominal organs occurred during the intraoperative puncture. No postoperative blood transfusion was needed in any patient, nor did fever and secondary hemorrhage occur. The mean operation duration was 98 min (range, 60–150 min), and the mean lithotripsy time was 45 min (range, 30–85 min). Additional postoperative extracorporeal shock wave lithotripsy (ESWL) was performed on six patients. High-power holmium laser PCNL in combination with ultrasound lithotripsy is safe, effective, and minimally invasive, with a high stone-free rate, especially for complicated renal calculi.     

微创经皮肾镜联合输尿管软镜碎石术治疗孤立肾鹿角形结石的临床研究

目的:探讨微创经皮肾镜取石术(MPCNL)联合输尿管软镜碎石术(FURSL)治疗孤立肾鹿角形结石的临床疗效,并对该方法的安全性、高效性及可行性进行评估。方法:研究纳入孤立肾鹿角形结石患者20例,对结石的位置和表面积进行统计。患者在知情同意后,先对其进行第一阶段的MPCNL治疗。术后5~7天,将第二阶段的MPCNL和FURSL相结合进行治疗。并对术中情况、结石清除率(SFR)和术后并发症进行评估,测量并记录患者术前、术后1个月以及每次复查时的血肌酐(Scr)、肾小球滤过率(GFR)和慢性肾脏疾病分级(CKD)。结果:所有患者均存在多个肾盏的鹿角形结石,结石平均大小为(1 099.9±843.95)mm2。所有患者均只有一处经皮入路,平均手术时间为(154.37±32.45)min,平均失血量为64(12~140)ml,最终SFR为90%。随访1个月,4例患者的CKD情况有所改善,2例CKD为5级的患者术后仍然需要透析,其余患者术前平均Scr为(187.16±94.12)μmol/L,术后1个月为(140.99±57.92)μmol/L,差异具有统计学意义(P=0.019)。GFR术前为(43.80±24.74)ml/min,术后随访1个月末为(49.55±21.18)ml/min,差异具有统计学意义(P≤0.05)。结论:MPCNL和FURSL联合治疗孤立肾鹿角形结石,可以有效地减少经皮入口的大小和数量,使得孤立肾结石患者的治疗更安全、可行且高效,进而得到满意的SFR,减少失血量及多入口相关的潜在并发症。在短期及长期愈后方面,该方法均不会对肾功能产生不利影响。     

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.     

三种经皮肾穿刺取石术治疗上尿路结石对照分析

目的：比较李氏肾镜与标准经皮肾镜及微创经皮肾输尿管镜治疗上尿路结石的有效性与安全性,提高上尿路结石的治疗水平.方法：2005年1月～2009年1月,三种经皮肾穿刺取石术治疗上尿路结石132例,其中包括肾结石87例（包括肾脏单发及多发结石56例,鹿角型结石31例）,输尿管上段结石45例.标准经皮肾镜取石术34例,年龄34～78岁,平均57岁;结石大小2.3～5.8 cm,平均3.5 cm;鹿角型结石14例.微创经皮肾输尿管镜取石术52例,年龄31～77岁,平均51岁;结石大小2.1～5.0 cm,平均3.3 cm;鹿角型结石8例.经皮李氏肾镜取石术46例,年龄29～81岁,平均55岁;结石大小2.0～5.5 cm,平均3.0 cm;鹿角型结石9例.对三组患者手术时间、留置造瘘管时间、I期结石清除率及手术出血进行比较.结果：李氏肾镜治疗输尿管上端结石（L4）手术时间（56±5）min,治疗上尿路结石I期手术清除率为80.43%,出血量为（156±38）ml,输血率2.17%,与标准经皮肾镜及微创经皮肾输尿管镜比较,差异均有统计学意义（P＜0.05）.对李氏肾镜治疗6例肾盂单发结石患者实行＂无管化＂,均恢复较好,无一例发生出血、漏尿及感染.结论：李氏肾镜在微造瘘经皮肾手术中较标准肾镜和输尿管镜代肾镜具有操作更简化、手术效率更高、剩余结石更少、并发症减少等优点.     

肾盂切开钬激光碎石取石术治疗孤立肾巨大鹿角形结石的疗效观察

目的：探讨和评价经肾盂切开钬激光碎石取石术治疗孤立肾巨大鹿角形结石的安全性和疗效。方法：回顾性分析接受经肾盂切开配合钬激光碎石取石术治疗的7例孤立肾巨大鹿角形结石患者的临床资料。结果：7例患者均手术顺利．术中出血量80～250ml,平均150ml、随访6～21个月,肾功能4例恢复正常．3例接近正常值范围．复查B超无结石残留。结论：该术式具有术中出血少、手术安全、对肾功能无明显影响、结石取净率高等优点,是一种处理孤立肾巨大鹿角形结石的较好方法。     

复杂肾结石经皮肾镜取石术后结石残留的原因与处理

目的:探讨复杂肾结石PCNL术后结石残留的原因及处理方法.方法:回顾分析我院行二期PCNL取石的35例复杂肾结石患者的临床资料,既往有开放手术史17例,2例因术中出血影响视野改二期手术,合并肾盏憩室内结石2例.结果:除2例需辅助ESWL治疗外,其余33例在B超和输尿管镜辅助下,行二期PCNL全部成功取净残留结石.其中3例因残留结石所在肾盏位置远离经皮肾通道或在与皮肾通道平行的肾盏内,重新建立另一通道取石;1例行3通道取石.结论:术中出血、肾盏憩室内结石、既往开放手术史和肾内集合系统解剖异常,是PCNL术后结石残留的主要原因;术中B超及软镜的应用,可以清楚显示有无残留结石及其所在肾盏的位置;了解结石与经皮肾通道的位置关系,帮助引导最大限度地清除结石.     

Urothelial cancer of the renal pelvis in percutaneous nephrolithotomy patients

INTRODUCTION: The association between staghorn calculus of the kidney long-standing and urothelial tumors of the renal pelvis is well documented. We describe 3 patients with urothelial cancer in a kidney who underwent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Retrospective analysis of our series of more than 500 PCNLs revealed 3 patients in whom urothelial cancer of the renal pelvis was diagnosed during or following percutaneous stone removal. Preoperative assessment included IVP, renal sonography and renal scan using DTPA in all 3 patients, and CT in 2 patients. Imaging did not raise the suspicion of a neoplastic lesion. RESULTS: All patients had a long history of urolithiasis and urinary infections. No patient was diagnosed preoperatively. One patient was diagnosed postoperatively, when a CT demonstrated a renal lesion. The second patient underwent simple nephrectomy due to a non-functioning kidney, and the tumor was found on pathological analysis. In the third patient, biopsies were taken from a suspicious-looking tissue in the renal pelvis during the PCNL session. All patients had transitional cell carcinoma: 1 associated with sarcomatoid features and 1 with squamous carcinoma. They all died from metastatic disease 2-19 months after the diagnosis of urothelial cancer. CONCLUSIONS: The preoperative diagnosis of urothelial cancer in patients with staghorn stones is difficult due to the existing stone and inflammation. Since the prognosis of urothelial cancer is extremely poor, biopsies of the renal pelvis, obtained directly through the nephroscope during the PCNL session, may be the only key for early diagnosis and treatment. A high index of suspicion should be raised when patients suffering from infected staghorn calculi are encountered, and such intraoperative biopsies should be considered.     

Supra-costal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: a prospective study of safety and efficacy of supra-costal versus sub-costal access

Background

To assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access.

Methods

From January 2010 to December 2014, a single surgeon performed 118 consecutive one-stage fluoroscopic guided PCNL’s for complex renal and upper ureteral stone. Our definition for complex renal stone is defined as partial or complete staghorn stone, multiple renal stones in more than 2 calyxes, obstructive uretero-pelvic stone >?2?cm, and a renal stone in single functional kidney. Inclusion criteria include: staghorn stones, renal calculi >?2?cm in diameter, upper ureteral stone >?1.5?cm in diameter. Exclusion criteria for tubeless PCNL include: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed.

Results

Of the 118 consecutive PCNL, eighty-six patients underwent tubeless PCNL (56 supra-costal and 30 sub-costal) and included in our prospective follow-up period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than sub-costal. Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, sub-costal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in sub-costal group was 50% (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% [supra-costal (1/56), sub-costal (4/30)] with the majority being infectious complications.

Conclusions

Supra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.

     

Percutaneous nephrolithotomy in patients aged 60 years or older

PURPOSE: To assess the safety and efficacy of percutaneous nephrolithotomy in patients more than 60 years old. PATIENTS AND METHODS: We retrospectively evaluated and compared the data of 28 percutaneous nephrolithotomies (PCNL) performed on 27 patients aged 60 years and older (mean 65.8) with the data of the remaining 178 PCNL procedures on 166 patients performed in our clinic between December 1997 and December 1999. RESULTS: Although staghorn stones seemed to be more common in the elderly group (25% v 22%), no statistical significance was demonstrated (P = 0.715), and the stone burden was similar for the two groups (P = 0.112). The only interesting finding in terms of patient characteristics was a significantly higher incidence of solitary kidney in patients aged 60 years or older (29% v 7%; P = 0.003). The success rates (stone-free patients and patients with residual stones <4 mm) were similar, being 89% for the elderly group and 92% for the younger patients (P = 0.718). Transfusion rates were also similar (21.4% in the elderly v 18% in the younger group; P = 0.662). No significant complication was observed in this elderly group, and no renal deterioration has been detected even in the follow-up of patients with a solitary kidney. CONCLUSIONS: Despite the somewhat higher stone burden in the elderly patients (1077.92 mm2 v 920.85 mm2), the stone-free rate was similar to that obtained in the younger patients, without any higher rates of complications or blood transfusions or longer hospital stay. Percutaneous nephrolithotomy is a safe and effective method of stone treatment in the elderly, even if they have a solitary kidney or complex calculi.     

Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi

There has been continuing controversy regarding multiple tracts in a percutaneous nephrolithotomy (PCNL) session that may bring more complications, especially severe bleeding need for transfusion, even nephrectomy. Little tracts may bring less trauma to renal parenchyma than standard PCNL tracts. We carried minimally invasive PCNL (MPCNL) in treating staghorn calculi with multiple 16Fr percutaneous tracts in a single session, in an attempt to get high stone free with little trauma, and compared the morbidity of standard PCNL procedures in a prospective trial. A total of 54 consecutive patients with staghorn calculi were prospectively randomized for MPCNL (29) and PCNL (25). The size and location of stone, operative parameters, number of tracts, stone-free rate, operating time, hospital stay and complications were analyzed. In MPCNL group, a total of 67 percutaneous tracts were established in 29 renal units, while 28 tracts in 25 renal units in PCNL group. Compared to PCNL, MPCNL was associated with higher clearance rate (89.7 vs. 68%, p = 0.049), less chance need for adjunctive procedure of SWL or second-look PCNL (24.1 vs. 60%, p = 0.007), while a similar complication rate (37.9 vs. 52%, p = 0.300). In conclusion, with the development of instruments and increased experience, judiciously made multiple percutaneous tracts in a single session of MPCNL for treating staghorn calculi were safe, feasible and efficient with an acceptable morbidity.     

经皮肾镜碎石取石术严重出血的相关因素分析

目的探讨经皮肾镜碎石取石术（PCNL）严重出血的有关风险因素,为预防和减少因PCNL而导致严重出血提供依据。 方法回顾性选取2014年8月至2017年8月收住我院行PCNL的650例上尿路结石患者资料。对患者一般状况,如年龄、性别、孤肾、高血压、糖尿病、术前凝血功能、术前肌酐值、肾积水程度、泌尿系感染等,结石的多少、大小、位置、形态,术者操作因素（术中通道数目、单通道的大小、单通道的入路、单通道的穿刺位置、分期手术、手术时间）进行单因素χ²检验,再对有意义的指标行多因素Logistic回归分析。 结果χ²检验显示高血压、糖尿病、术前凝血功能异常、术前肌酐值>115 μmol/L即肾功能不全、泌尿系感染、中重度肾积水、多发肾结石、结石位于肾盂和肾盏、术中多通道、术中较大穿刺通道、二期手术、手术时间超过90 min与PCNL术后严重出血有关（P<0.05）。Logistic回归分析,术中较大穿刺通道、手术时间超过90 min、泌尿系感染、肾功能不全与PCNL术后严重出血有关（P<0.05）。 结论术中较大穿刺通道、手术时间超过90 min、泌尿系感染、肾功能不全是PCNL术后严重出血的危险因素。     

Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study

A randomized controlled study was performed to evaluate the feasibility and outcome of staged versus simultaneous bilateral tubeless PCNL for bilateral renal staghorn stones. A total of 99 patients, with bilateral renal staghorn stones, were prospectively randomized into two groups, and underwent staged tubeless PCNL (49 patients) or simultaneous bilateral tubeless PCNL (50 patients). Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months thereafter, and Tc 99m DTPA clearance for determination of selective glomerular filtration rate was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, and complication grading. The length of stay, convalescence period, pain visual analog scale, analgesic requirements, and direct cost favored the simultaneous bilateral tubeless group with statistical significance. There was no significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This study demonstrates that simultaneous bilateral tubeless PCNL is a safe, efficacious, and cost-effective option in bilateral renal staghorn calculi, which is associated with low morbidity, short hospital stay, high stone-free rate, and early return-to-normal activity.     

Tubeless percutaneous nephrolithotomy: Experience of 1000 cases at a single institute

ObjectiveTo access the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL).Materials and methodsSince January 2001, 1000 consecutive tubeless PCNLs performed at our hospital were enrolled into this retrospective chart review. The average age of the patients (659 males and 341 females) was 54.4 ± 12.6 years, and 55 patients were 75 years old or older. The stone characteristics were 490 non-complete staghorn kidney stones, 218 ureteral stones, 119 kidney + ureteral stones and 173 complete staghorn stones. The mean stone size was 3.5 ± 2.0 cm, and 200 patients had stone size ≥5.0 cm. The average operative time was 78.0 ± 29.4 minutes. The stone free rates were 78.8%, 100%, 84.9% and 45.0% for kidney, ureter, kidney + ureter and complete staghorn stones, respectively, with an overall stone free rate of 78.3%. The average postoperative hospital stay was 3.6 ± 2.1 days, and the blood transfusion rate was 2.4%. Postoperative fever was noted in 104 patients, and urosepsis was noted in 13 patients. Pulmonary complication included hydrothorax in 5 patients, hemothorax in 2 patients, pneumothorax in 2 patients and acute pulmonary edema in 1 patient. Cadiovascular complications included congestive heart failure in 1 patient and pneumomediastinum in 1 patient.ConclusionOur study demonstrated that sith adequate hemotasis, tubeless modification is a safe modality for PCNL.     

经皮肾镜取石术治疗鹿角形肾结石通道建立技巧的探讨

目的：探讨经皮肾镜取石术（PCNL）治疗鹿角形肾结石术中穿刺点、穿刺径路的合理选择及扩张、通道建立的技巧。方法：总结在X线定位下PCNL治疗36例鹿角形肾结石患者的经皮肾通道建立与治疗效果。结果：Ⅰ期手术穿刺、通道建立、成功碎石率100％;Ⅰ～Ⅲ期结石完全清除率83．33％;单通道26例（72．22％）,双通道7例（19．44％）,三通道3例（8．33％）;无大出血、感染休克等严重并发症发生。结论：PCNL治疗鹿角形肾结石的第一个穿刺点首选中后组盏,径路应与目标盏长径相吻合;带鞘扩张时扩张器应进入集合系统内约2cm,退出扩张器直接完成通道建立;Ⅰ期建立单通道处理。肾盂、中组肾盏结石为主,Ⅱ期先经Ⅰ期通道处理上下盏残留结石,慎重建立第二、三条经皮肾通道。     

预留导丝在复杂性肾结石行经皮肾镜术中的应用

目的探讨预留导丝在复杂性肾结石行经皮肾镜碎石取石术（PCNL）中的应用价值。 方法2014年5月至2017年9月我院术前评估为复杂性肾结石患者63例,其中鹿角形结石34例,结石平均大小（4.8±1.8） cm,多发性结石29例,分布肾盏个数（8.2±4.2）个。在建立通道前视结石分布情况,预留导丝并固定,然后根据保留的导丝建立经皮肾通道行PCNL术。 结果一期手术完全清除结石52例,清除率为82.6%;二期手术11例,总手术清除率为95.1%,手术时间、住院时间分别为（83.5±40.8） min、（8.2±3.7）d,所有病例均无胸膜、肠管、肝脾等脏器损伤,无输血及肾血管栓塞等病例。 结论对于复杂性肾结石,预留导丝可以简化操作步骤、精准穿刺目标肾盏,有利于提高PCNL的结石清石率,缩短手术时间,值得临床推广。     

Staged single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney

The aim of this study was to evaluate the outcome of staged single-tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy as a minimally invasive option in the treatment of staghorn stone in patients with a solitary kidney. A total of 24 patients with staghorn stone in a solitary kidney were treated with single-tract MPCNL and flexible ureteroscopy by a single surgeon. All the patients underwent single-tract MPCNL through a 20 F tract and had most of the intrarenal calculi removed at the first stage. The second stage of retrograde flexible ureteroscopy was performed 3–5?days later, after the drainage was cleared. The preoperative patient, characteristics, stone size, operative time, renal functional status and postoperative outcomes were then evaluated. Sixteen patients were partial staghorn (66.7?%), and other eight were complete staghorn (33.3?%). The overall stone-free rate was 83.3?% after the second-stage procedures, and only four patients had significant residue. The hemoglobin drop ranged from 1.1 to 3.7?g/dl, and three patients required blood transfusion. The mean serum creatinine value was 1.7?±?0.5?mg/dl before surgery and 1.3?±?0.4?mg/dl at the end of the follow-up period with statistical significance (P?<?0.05). None of the patients had increased serum creatinine, and needed dialysis at the end of the follow-up period. Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of staghorn stone in patients with a solitary kidney and even in patients with impaired renal functions.     

Clinical study of extracorporeal shock wave lithotripsy for stones in solitary kidney

Extracorporeal shock wave lithotripsy (ESWL) treatment was performed on 17 patients with a solitary or sole functioning kidney from August 1986 to April 1988. Some patients with renal stone had a double pig tail catheter to protect the stone street and those with ureteral stones had a ureteral balloon occlusion catheter to raise the efficiency of fragmentation placed prior to ESWL as much as possible. Combined manipulation with such an instrument as nephrostomy tube to wash out residual stone fragments or endoscopic operation were performed. Despite of these devices, ESWL treatments for staghorn calculi and cystine stones were troublesome in solitary kidneys. After follow up ranged from 9 to 602 days (mean 87.6 days), 10 patients (58.8%) were stone free. ESWL treatment is safe and effective for solitary kidneys. We recommended premedication and pretreatment by ureteral stenting in patients with a solitary kidney.     

Success of electromagnetic shock wave lithotripter as monotherapy in large renal calculi—Our experience

ObjectivesTo evaluate the success of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Hence, if our study result demonstrates acceptable success and safety, we can recommend ESWL as a treatment option for patients with large renal calculi.Subjects and methodsThis is a prospective study conducted in the Department of Urology, Regional Institute of Medical Sciences, Imphal, India, from January 2011 to December 2012. A total of 104 patients aged between 20 and 70 years with solitary large (>2 cm) renal stones underwent ESWL using the Dornier Compact Sigma Lithotripter. Stone size was calculated by measuring the largest dimension of the stone in KUB plain films. In each session, 3000–3500 shocks at frequency 60–90 min^?1 and intensity between 1 and 4 were given. A maximum number of six sessions were given. Successful treatment was defined as complete clearance or residual stones smaller than 4 mm on KUB performed 3 months after the first session.ResultsTotal number of patients was 104. The M:F ratio was 1:1.4. The stone size ranged from 21 to 55 mm. The overall success rate was 73%. For stones >30 mm, the success rate was only 62.2% (n = 28). The number of sessions required increased as the stone size increased. The most common complication encountered was haematuria.ConclusionESWL remains the cornerstone of therapy for renal calculi less than 2 cm. Our study reveals that multiple sessions were required for solitary renal calculi, with higher rate of ancillary procedures. The success rate of ESWL for both non-staghorn and staghorn calculi with size above 2 cm is low, so other treatment modalities like PCNL should be considered as the first treatment option. However, with appropriate patient selection, significant improvements in stone-free rates may be achieved.     

经皮肾镜碎石取石术治疗孤立肾结石的临床分析

目的 探讨经皮肾镜碎石取石术治疗孤立肾结石的临床疗效及分析手术并发症的危险因素.方法 回顾性分析本院2009年11月至2016年1月行经皮肾镜碎石取石术治疗的孤立肾结石患者,记录患者的一般资料、术中及术后情况,记录术前术后血红蛋白、血肌酐并进行比较;Logistic回归分析评估出血及手术并发症的相关危险因素.结果 本组32例,男性9例,女性23例,平均年龄47.75(29 ～ 67)岁,平均BMI 23.7(18.2 ～ 28.4) kg/m2,鹿角形结石1例,多发结石11例,平均结石含量501.25(300 ～ 800) mm2,Guys结石分级:1级11例(34.4％)、2级9例(28.1％)、3级11例(34.4％)、4级1例(3.1％).4例患者建立两个经皮肾通道;平均手术时间73.75(40 ～ 120) min,平均术中估计出血量85 (40～300)mL,26例患者结石完全清除,总的结石清除率81.25％.3例患者发生手术并发症.手术前后血红蛋白、血肌酐均未发生明显变化.Logistic回归分析提示多个经皮肾通道的建立增加出血风险,手术时间延长增加手术并发症的发生.结论 经皮肾镜碎石术治疗孤立肾结石排石率高、手术并发症少.多个经皮肾通道的建立增加手术出血风险.