微创经皮肾镜与输尿管软镜治疗2～4 cm肾下盏结石的比较

目的比较微创经皮肾镜碎石取石术（MPCNL）和输尿管软镜碎石术（RIRS）治疗2～4 cm肾下盏结石的效果。 方法我们回顾性分析新疆医科大学第六附属医院、深圳市宝安区中心医院和新疆自治区人民医院三家医院从2011年6月至2016年6月治疗直径范围2～4 cm肾下盏结石167例病例资料,根据手术方式不同分为两组：MPCNL 98例,RIRS 69例。 结果MPCNL组手术时间（84±28）min,短于RIRS组（116±23）min（P<0.001）;MPCNL术中血红蛋白下降值（5.2±1.6）g/L,明显高于RIRS组（1.9±0.4）g/L（P<0.001）;住院时间（8.5±1.4）d,明显长于RIRS组（3.8±1.2）d（P<0.001）;术后并发症率MPCNL组14.3％（14/98）高于RIRS组4.3％（3/69） （P=0.036）;MPCNL一期清石率87.8％（86/98）高于RIRS组55.1％（38/69） （P<0.001）;总清石率分别为93.9％（92/98）和91.3％（63/69）,两者接近（P=0.506）。 结论MPCNL是治疗2～4 cm肾下盏结石的有效手段,但为了更加微创、出血更少、住院时间更短,RIRS在一定程度上可以作为治疗肾下盏结石的一种有效的替代手术方式。     

A prospective randomized comparison of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones

Objective

To make a comparison between the safety and efficacy of micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones up to 15 mm.

Patients and methods

60 patients presenting with solitary lower pole kidney stones up to 15 mm were included in the study between March 2013 and December 2015. Patients were randomized into Microperc or RIRS groups with computer-generated numbers.

Results

The mean stone size was 10.6 (5–15) and 11.5 (7–15) mm for Microperc and RIRS groups, respectively (P = 0.213). In the Microperc group, the scopy time was 158.5 s, while in the RIRS group, the scopy time was 26.6 s (P = 0.001). The hospitalization period in the Microperc group was 542 h, while it was 19 h in the RIRS group (P = 0.001). No statistical differences were observed during the operating time, pre-operative–post-operative hemoglobin (Hb), serum creatinine, and estimated glomerular filtration speed (e-GFR) values and stone-free rates. No intraoperative complications were observed in either of the groups, while post-operative complications were observed in six patients in Microperc Group and five patients belonging to the RIRS Group (P = 0.922).

Conclusions

Both Microperc and RIRS are safe and effective alternatives, and have similar stone clearance and complication rates for the management of lower pole kidney stones up to 15 mm in diameter. However, prolonged hospital stay and scopy times are the main disadvantages of Microperc and further research is needed to evaluate the renal tubular damages caused by both of these methods.

     

Managing Small Ureteral Stones: A Retrospective Study on Follow-Up,Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

Introduction

The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm.

Objectives

We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free.

Materials and methods

192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed.

Results

Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm).

Conclusion

Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.Key Words: Conservative management, Cost-effective, Tamsulosin, Ureteral calculus, Urolithiasis     

Transurethral cystolitholapaxy with the AH-1 stone removal system for the treatment of bladder stones of variable size

Background

The treatment of large volume bladder stones by current equipments continues to be a management problem in both developing and developed countries. AH-1 Stone Removal System (SRS) invented by us is primarily used to crush and retrieve bladder stones. This study evaluated the safety and efficiency of transurethral cystolitholapaxy with SRS for the treatment of bladder stones of variable size.

Methods

SRS, which was invented by Aihua Li in 2007, composed by endoscope, continuous-flow component, a jaw for stone handling and retrieving, lithotripsy tube, handle, inner sheath and outer sheath. 112 patients with bladder stones were performed by transurethral cystolitholapaxy with SRS since 2008. We compare the surgical outcome to bladder stones of variable size, and evaluate the surgical efficiency and safety.

Results

Characteristics of patients and stone removal time in variable size were evaluated. To patients with single stone, stone size was 1.35 ± 0.37 cm and the operating time was 5.50 ± 3.92 min in Group A. Stone size was 2.38 ± 0.32 cm and the operating time was 11.90 ± 9.91 min in Group B. Stone size was 3.30 ± 0.29 cm and the operating time was 21.92 ± 9.44 min in Group C. Stone size was 4.69 ± 0.86 cm and the operating time was 49.29 ± 30.47 min in Group D. The difference was statistically significant between the four groups. Among them, 74 (66.07%) patients accompanied with benign prostatic hyperplasia (BPH) were treated by transurethral resection of the prostate (TURP) simultaneously. Compared between the four groups, the difference of the TURP time was not statistically significant, P >0.05. No significant complication was found in the surgical procedure.

Conclusions

Transurethral cystolitholapaxy with SRS appears to be increased rapidity of the procedure with decreased morbidity. It is a safe and efficient surgical management to bladder stones. This endoscopic surgery best fits the ethics principle of no injury; meanwhile, the accompanied BPH could be effectively treated by TURP simultaneously.     

Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy

Purpose

There is a lack of studies comparing shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) in renal stone treatment. This study compared treatment outcome, stone-free rate (SFR) and stone-free survival (SFS) with regard to stone size and localization.

Methods

This analysis included 482 first-time-treated patients in the period 2001–2007. Detailed clinical information, stone analysis and metabolic evaluation were evaluated retrospectively. Outcome, SFR and SFS were analyzed with regard to size (<1 vs. ≥1 cm) and localization (lower vs. non-lower pole).

Results

Higher SFRs in lower and non-lower pole stones ≥1 cm were confirmed for RIRS and MIP (p < 0.0001). A regression model confirmed a higher risk of non-lower pole stone persistence for SWL versus RIRS (OR: 2.27, p = 0.034, SWL vs. MIP (OR: 3.23, p = 0.009) and larger stone burden ≥1 versus <1 cm (OR: 2.43, p = 0.006). In accordance, a higher risk of residual stones was found in the lower pole for SWL versus RIRS (OR: 2.67, p = 0.009), SWL versus MIP (OR: 4.75, p < 0.0001) and stones ≥1 cm versus <1 cm (OR: 3.02, p = 0.0006). In RIRS and MIP patients, more complications, stenting, prolonged disability, need/duration of hospitalization and analgesia were noticed (p < 0.05). Overall SFS increased from SWL, RIRS, to MIP (p < 0.001). SWL showed lower SFS for non-lower pole (p = 0.006) and lower pole stones (p = 0.007).

Conclusions

RIRS and MIP were shown to have higher stone-free rates and SFS compared to SWL. The price for better outcome was higher, considering tolerable complication rates. Despite larger preoperative stone burden, MIP achieved high and long-term treatment success.     

Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy

Introduction

Achieving stone free status (SFS) is the goal of stone surgery. In this study it is aimed to compare effectiveness of unenhanced helical computerized tomography (UHCT), KUB and ultrasonography (US) for detection of residual RFs and predicition of stone releated events following percutaneous nephrolitotomy (PNL).

Materials and Methods

Patients underwent PNL for radiopaque stones between November 2007 and February 2010 were followed. Patients were examined within 24-48 hours after the procedure by KUB, US and UHCT. For stone size 4 mm was accepted as cut off level of significance.Sensitivity and specificity of KUB and US for detection of RFs and value of them for prediction of stone related events were calculated.

Results

SFS was achieved in 95 patients (54.9%) and when cut off value of 4 mm for RFs was employed, SFS was achieved in 131 patients (75.7%). Sensitivity was 70.5% for KUB, and 52.5% for US. UHCT was shown to be significantly more efficient for detection of RFs compared to both KUB (p=0.01) and US (p=0.001). When cut off level of 4 mm employed, sensitivity of KUB and US increased to 85.7% and 57.1%. Statistical significant superiority of UHCT still remained (p value vs. KUB: 0.03 and p value vs. US: 0.008).

Conclusion

UHCT is the most sensitive diagnostic tool for detecting RFs after PNL. It has higher sensitivity regardless of stone size compared to KUB and US. Additionally UHCT has higher capability of predicting occurrence of stone related events.     

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

Background and Objectives:

Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi.

Methods:

We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging.

Results:

Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted.

Conclusions:

Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.     

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

The management of renal calculi following previous open surgery represents a challenge for urologists. The aim of this study is to evaluate the outcomes and safety of ureteroscopic laser retrograde intrarenal surgery (RIRS) for renal calculi following prior open renal surgery. The charts of 53 patients who underwent RIRS for renal calculi following prior open surgery for urolithiasis were reviewed. Both flexible and semi-rigid ureteroscopes were utilized together with holmium: YAG laser for stone disintegration. Intravenous urography, computed tomography (CT) and ultrasound were used to evaluate the patient, perioperatively. Stone size ranged from 5 to 32 mm (mean 14.3 mm). The mean operative time was 86 min (20-130). The overall stone-free rate was 92.4%. The overall stone-free rates after one and two-procedures were 79.2% (42 cases) and 92.4% (49 cases), respectively. Four patients (7.5%) had larger residual fragments, 2 (3.8%) of them underwent SWL, and 2 (3.8%) cases were followed up conservatively. Major complications were reported in two patients (3.8%). Stone analysis revealed calcium oxalate in 39 patients, uric acid in 5, calcium phosphate in 4, struvite in 3, and cystine in 2 cases. Ureteroscopic retrograde intrarenal surgery for renal calculi following prior open renal surgery was a minimally invasive, safe procedure with a high success rate. It is a viable alternative for PNL in managing recurrent renal calculi efficiently.     

Percutaneous Nephrolithotomy in Autosomal Dominant Polycystic Kidney Disease: Is it Different from Percutaneous Nephrolithotomy in Normal Kidney?

Objectives

Nephrolithiasis has been reported in 20-28% of patients, of whom 50% are symptomatic for stone disease and 20% require definite urologic intervention. The management of nephrolithiasis includes oral alkali dissolution therapy, extracorporeal shock wave lithotripsy and surgical treatment. In such patients, percutaneous nephrolithotomy (PNL) as a method of stone treatment has been reported in few cases with limited experience. The aim of this study is to present our experience of PNL in autosomal dominant polycystic kidney disease (ADPKD) and assessing the outcome results.

Material and Methods

From 2002 to 2011, 22 patients (26 renal units) suffering from ADPKD with stone were managed by PNL. Demographic characteristics, operative parameters and postoperative complications were recorded and analysed.

Result

The overall success rate of PNL was 82.1% and PNL with extracorporeal shock wave lithotripsy for clinically significant residual fragments was 92.85% respectively. The hematuria required blood transfusion (n = 9), postoperative fever due to cyst infection (n = 4) and paralytic ileus (n = 3) were recorded.

Conclusion

The PNL in ADPKD PNL is safe and effective but have more postoperative complications such as bleeding requiring transfusions, fever due to cyst infection and paralytic ileus.Key Words: Percutaneous nephrolithotomy, Nephrolithiasis, Autosomal dominant polycystic kidney disease     

Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones

Objectives

To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10–20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications.

Patients and methods

A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group.

Results

Success rates were 66.5, 91.4, and 87 % for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7 %, respectively; p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9 %, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively).

Conclusions

For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.     

The R.I.R.S. scoring system: An innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery

Background

To establish and internally validate an innovative R.I.R.S. scoring system that allows urologists to preoperatively estimate the stone-free rate (SFR) after retrograde intrarenal surgery (RIRS).

Methods

This study included 382 eligible samples from a total 573 patients who underwent RIRS from January 2014 to December 2016. Four reproducible factors in the R.I.R.S. scoring system, including renal stone density, inferior pole stone, renal infundibular length and stone burden, were measured based on preoperative computed tomography of urography to evaluate the possibility of stone clearance after RIRS.

Results

The median cumulative diameter of the stones was 14 mm, and the interquartile range was 10 to 21. The SFR on postoperative day 1 in the present cohort was 61.5% (235 of 382), and the final SFR after 1 month was 73.6% (281 of 382). We established an innovative scoring system to evaluate SFR after RIRS using four preoperative characteristics. The range of the R.I.R.S. scoring system was 4 to 10. The overall score showed a great significance of stone-free status (p?<?0.001). The area under the receiver operating characteristic curve of the R.I.R.S. scoring system was 0.904.

Conclusions

The R.I.R.S. scoring system is associated with SFR after RIRS. This innovative scoring system can preoperatively assess treatment success after intrarenal surgery and can be used for preoperative surgical arrangement and comparisons of outcomes among different centers and within a center over time.

     

Flexible ureteroscopy for lower calyceal stones in a horseshoe kidney – Is it the new treatment of choice?

IntroductionThe efficacy of retrograde intrarenal surgery (RIRS) for the treatment of disorders in a horseshoe kidney has not been sufficiently studied so far. We report on our experience with this method for the treatment of lower-pole calculi in patients with a horse-shoe kidney.Patients and methodsThe files of 9 patients who underwent RIRS for lower calyceal stones in horseshoe kidneys between April 2012 and December 2014 were retrospectively analyzed. The stone-free status, postoperative complications, operative time and duration of hospitalization were assessed.ResultsIn total, 12 renal units with lower calyceal stones were treated, as 3 patients had stones in both kidneys. In 8 renal units complete stone clearance could be achieved in one sitting (67.7%), while in 3 renal units 2 sittings were necessary in order to achieve stone clearance. One patient with a stone sized 18 mm still had residual stones after two sittings and, therefore, underwent percutaneous nephrolithotomy (PCNL) for stone clearance. No major complications (Clavien–Dindo grades III–V) were encountered.ConclusionRIRS for the treatment of stone disease in horseshoe kidneys has been shown to be a relatively safe and effective procedure. However, due to the anatomical abnormality, a second look may be needed to render the patient completely stone-free.     

Laparoscopic Ureterolithotomy

Background and Objective:

The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy.

Methods:

We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Although the retroperitoneal approach was preferred for 170 patients, the transperitoneal approach was used in the remaining 43 patients.

Results:

The mean patient age was 39.3 ± 12.0 years (range, 18–73). The study population was composed of 78 (26.7%) female and 135 (63.3%) male patients. The mean stone size was 19.7 ± 2.5 mm. The mean operative time was 80.9 ± 10.9 minutes, and the mean blood loss was 63.3 ± 12.7 mL. Intraoperative insertion of a double-J catheter was performed in 76 patients. The overall stone-free rate was 99%. No major complication was observed in any patient. However, conversion to open surgery was necessary in 1 patient.

Conclusion:

With high success and low complication rates, laparoscopic ureterolithotomy is an effective and reliable method that ensures quick recovery and may be the first treatment option for patients with large, impacted ureteral stones, as well as for those with a history of failed primary treatment.     

逆行肾内手术治疗不同大小肾结石的疗效分析

目的探讨逆行肾内手术（RIRS）治疗肾结石的临床疗效、安全性及适应证。方法回顾性分析2008年3月至2013年5月采用RIRS治疗432例肾结石患者的临床资料,对患者手术时间、术后结石清除率、并发症发生率进行评估。结果本组RIRS术432例,其中≤2cm结石患者272例,平均手术时间为（81．6±23．7）min,一期结石清除率为87．8％;2cm至3cm肾结石133例,平均手术时间为（163．3±71．5）min,一期结石清除率为72．2％;〉3cm结石27例,平均手术时间为（163．3±58．3）min,一期结石清除率为40．7％。术中发生输尿管穿孔性损伤17例（3．9％）,术后22（5．1％）例体温超过38．5℃,7例（1．6％）出现尿脓毒血症,经抗感染及支持治疗等治疗缓解。比较结石直径≤2cm组和2cm〈直径≤3cm的一期清石率,无显著性差异（P〉0．05）;比较结石直径≤2cm组和结石直径〉3cm的一期清石率,有显著性差异（P〈0．05）。结论对于≤3cm的肾结石,RIRS具有创伤小,恢复快,结石清除率高等优点,值得推广。     

Urinary kidney injury molecule-1 levels in renal stone patients

Objective

To study kidney injury molecule-1 (KIM-1) biomarker levels, indicating renal tubular damage, in patients with kidney stones and in those who underwent minimally invasive method stone treatment.

Patients and methods

Sixty patients with renal stones between 10 and 20 mm were included into the present study. Patients who were divided into three cohorts underwent micropercutaneous nephrolithotomy (microperc), retrograde intrarenal stone surgery (RIRS), and percutaneous nephrolithotomy (PNL). Urine samples were obtained from all participants before, 4 h and 14 days after the procedure. In all the samples obtained, urinary KIM-1 and creatinine (Cr) levels were measured and KIM-1/Cr ratios (ng/mg creatinine) were calculated.

Results

Preoperative urine KIM-1/Cr ratio was higher than postoperative 14th day. The bigger the renal stone size, the higher was the ratio (correlation coefficient 0.353, p = 0.006). According to preferred treatment procedure, there was a statistically significant decrease in preoperative and postoperative 4th hour and 14th day urine KIM-1/Cr rates in the RIRS and PNL, yet none in the microperc group (p = 0.010, p = 0.001, p = 0.212, respectively).

Conclusion

In renal stone patients, the elevated urine KIM-1/Cr ratio levels increase further according to stone size. KIM-1/Cr ratio is a promising marker might be helpful in monitoring the damage created by stone disease.

     

Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones

OBJECTIVE: The newer flexible ureteroscopes, 150-200-microm holmium YAG laser fibres and superflexible Dormia baskets have made it possible to reach and treat stones in all parts of the kidney. The object of this evaluation was to study the outcome of retrograde intrarenal stone surgery (RIRS) for extracorporeal shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A total of 38 consecutive patients (18 males, 20 females) participated in the study. All patients had undergone ESWL prior to RIRS without success. In all cases the stones could be reached with the endoscope. Calculi ranged in size from 3 to 20 mm (mean 9 mm). In 32 cases the stones were fragmented using a holmium YAG laser and in six the stones could be extracted using zero-tip Dormia baskets without fragmentation. Sixteen patients had lower calyceal calculi and eight had an abnormal anatomy of the upper urinary tract. Intravenous pyelography was performed 6-8 weeks after the treatment. RESULTS: In all cases the stones could be reached and fragmented to some extent. After a single RIRS procedure, 22/38 patients (58%) were completely stone-free at follow-up, and four (11%) had residual fragments < or = 4 mm in size that were expected to pass spontaneously. Of the remaining 12 patients, who initially had larger stones (mean 11.3 mm), the residual fragments ranged in size from 5 to 15 mm. Three patients underwent an additional RIRS procedure, after which they were all completely stone-free, resulting in an overall success rate of 76%. There were no major complications. CONCLUSIONS: RIRS is a safe procedure with a high success rate and a low complication rate for ESWL-resistant renal stones. Patients with larger stones (> 10 mm), those with stones in the lower pole and those with an abnormal renal anatomy may require more than one procedure.     

Incidence of retrorenal colon during percutaneous nephrolithotomy

Objective

The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic.

Materials and Methods

Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated.

Results

According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images.

Conclusions

PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon.     

经皮肾镜和逆行输尿管软镜处理≤2 cm肾结石的比较

目的比较经皮肾镜取石取石术（PCNL）和逆行输尿管软镜碎石取石术（RIRS）治疗≤2 cm肾结石的疗效。 方法回顾性分析2015年10月至2016年11月广西医科大学第一附属医院泌尿外科收治的96例≤2 cm肾结石患者的临床资料,按术式将其分为PCNL组42例和RIRS组54例。比较分析两组术前准备时间、手术时间、碎石时间、术后住院时间、住院费用、术后清石率、并发症发生率等。 结果42例PCNL患者中,36例患者结石一次碎石完成,3例患者分2次碎石完成,3例患者残留结石。54例RIRS患者中,48例患者结石一次碎石完成,6例患者残留结石。PCNL组和RIRS组术后1周结石清除率分别为78.57%（33/42）和57.41%（31/54）,术后1个月结石清除率分别为92.86%（39/42）和88.89%（48/54）。平均手术时间PCNL组（70±15）min,RIRS组（54±13）min。平均碎石时间PCNL组（32±13）min,RIRS组（39±13）min。术前准备时间PCNL组4（2）d,RIRS组3（2）d。术后住院时间PCNL组5（4）d,RIRS组1（1）d。平均住院费用PCNL组（19 195±3 809）元,RIRS组（13 319±1 537）元。并发症发生率PCNL组23.81%（10/42）,RIRS组3.70%（2/54）。 结论相对于PCNL,RIRS在处理≤2 cm的肾结石在术后住院时间、并发症发生率、平均住院费用上有优势,而两者术后结石清除率相当。     

Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup

PURPOSE: Management of fragments generated by ureteroscopic laser lithotripsy remains controversial. In this study we explored the impact of active fragment extraction after ureteroscopic laser lithotripsy on stone clearance. MATERIALS AND METHODS: A total of 69 patients with 3 or less upper urinary tract calculi (5 to 15 mm) demonstrated on preoperative CT were prospectively evaluated. Stones were translocated to a dependent upper pole calix where laser lithotripsy was performed. An attempt was made to clear all fragments using tipless stone baskets. One month after surgery stone clearance was evaluated exclusively with noncontrast spiral CT. RESULTS: In 58 patients undergoing surgery on protocol, average stone burden was 9.4 +/- 3.4 mm and was significantly smaller in 44 patients with stones in a solitary location (8.5 +/- 2.9 mm) than in 14 patients with stones in multiple locations (12.3 +/- 3.2 mm, p <0.001). Primary stone location was categorized as renal nonlower pole (in 16), renal lower pole (in 19) and proximal ureter (in 23). Average operative time (43.7 +/- 18.4 minutes) was unaffected by stone location or multiplicity after controlling for stone size (p >0.05). Stone clearance rates were not affected by stone location or multiplicity, with overall success rates of 54%, 84% and 95% at fragment thresholds of 0, 2 and 4 mm, respectively (p >0.05). CONCLUSIONS: Ureteroscopic laser lithotripsy with active fragment extraction was time efficient and highly effective. Sensitive postoperative imaging reveals the challenge of achieving a true stone-free state. We were unable to demonstrate an impact of stone location on stone-free rates.     

Safety and efficacy of staged retrograde intrarenal surgery for large stone burden of renal stones in selected patients: A single-center experience

ObjectiveManagement of patients with upper ureteral and renal urolithiasis is challenging for endourologists. Since the advancements in endourological equipment/devices, retrograde intrarenal surgery (RIRS) has become an attractive, widespread technique for upper urinary tract stone manipulation, owing to its advantage of being noninvasive with higher stone clearance rate and less pain compared with traditional shock wave lithotripsy (SWL) and percutaneous nephrolithotripsy (PNL). However, the outcome and complication of staged RIRS for large stone burden (> 2.0 cm) management for renal stones still need to be reported. A total of 172 cases of renal calculi were treated by RIRS in a single center; among these, 22 had renal stone size larger than 2.0 cm. In this work, we present our experience and treatment outcomes of these patients.Materials and methodsBetween August 2015 and January 2016, we enrolled 172 patients with upper urinary tract calculi who underwent RIRS with holmium laser lithotripsy performed by one surgeon in a singer center. Based on a medical record review, we collected data pertaining to the outcomes and complications of RIRS.ResultsA total of 172 patients with upper urinary tract stones were included in this study (113 male and 59 female patients). All patients underwent RIRS with holmium laser lithotripsy procedure. The overall stone-free rate (SFR) was 90.6%. The average stone size was 0.8 cm with average operation time of 89.7 minutes. Average hospital stay was 2.7 days. The average pain score was 2.38/10 by the Numerical Rating Scale. In the large stones size subgroups, the SFR of stone burden between 2.0 cm and 3.0 cm was 80.2%, and the SFR of stone burden over 3.0 cm was 45.0% by single RIRS. Ten of 22 patients underwent two-staged RIRS and their SFR improved from 45.0% to 76.5%. No major complications (Clavien III–V) were noted in the study groups.ConclusionTo the best of our knowledge, RIRS for large renal stone manipulation is an effective and safe treatment modality currently. In our study, the single RIRS SFR was superior to PNL or SWL even when the stone burden was between 2.0 cm and 3.0 cm (80.2%). For those patients whose stone burden was over 3.0 cm or for those with comorbidities, staged RIRS resulted in a lower complication rate, reduced hospital stay, and better SFR (76.5%).