Minervini Andrea, Davenport Kim, Keeley Francis X, Timoney Anthony G
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Eur Urol. 2006 Mar;49(3):536-42; discussion 542-3. doi: 10.1016/j.eururo.2005.11.025. Epub 2005 Dec 28.
To compare complication and success rates of antegrade and retrograde endopyelotomy performed over 10 years and to define possible risk factors associated with treatment failure.
From 1994 to 2004, 61 patients underwent a total of 68 endoscopic treatments: 19 antegrade and 49 retrograde endopyelotomy procedures. Antegrade endopyelotomy was always performed using diathermy. In the first 18 procedures retrograde endopyelotomy was performed using diathermy. In the most recent 30 procedures the incision was made using holmium laser. Endoluminal ultrasound was used in 78% of retrograde endopyelotomy and in 5% of antegrade endopyelotomy.
The retrograde endopyelotomy patients demonstrated significantly lower complication rates (12.5% vs. 42%) and shorter hospital stay (1.5 vs. 7 days) than the antegrade endopyelotomy patients. The mean follow up of the patients who remained free from disease recurrence during the study period was 46 and 24 months for the antegrade and retrograde endopyelotomy group, respectively. The overall success rate (mean time to failure) of antegrade and retrograde endopyelotomy was 56% (31 months) and 70% (17 months), respectively. There was no statistically significant increase in the overall success rate of retrograde endopyelotomy using endoluminal ultrasound per se. Stratifying retrograde endopyelotomy by the type of energy used for the incision, the overall success rate (mean time to failure) was 80% (10 months) and 53% (21 months) for Holmium laser and diathermy, respectively (p = 0.0626).
The overall success of antegrade and retrograde endopyelotomy in this series appears to be largely a factor of lead-time bias and is similar enough to recommend retrograde endopyelotomy with holmium laser on the basis of its relative safety and shorter hospital stay.
比较10年间顺行性和逆行性肾盂内切开术的并发症及成功率，并确定与治疗失败相关的可能危险因素。
1994年至2004年，61例患者共接受了68次内镜治疗：19次顺行性和49次逆行性肾盂内切开术。顺行性肾盂内切开术均采用透热疗法。在前18例手术中，逆行性肾盂内切开术采用透热疗法。在最近的30例手术中，切口采用钬激光。78%的逆行性肾盂内切开术和5%的顺行性肾盂内切开术使用了腔内超声。
逆行性肾盂内切开术患者的并发症发生率（12.5%对42%）和住院时间（1.5天对7天）显著低于顺行性肾盂内切开术患者。在研究期间未出现疾病复发的顺行性和逆行性肾盂内切开术患者的平均随访时间分别为46个月和24个月。顺行性和逆行性肾盂内切开术的总体成功率（平均失败时间）分别为56%（31个月）和70%（17个月）。使用腔内超声本身并未使逆行性肾盂内切开术的总体成功率有统计学意义的提高。根据用于切口的能量类型对逆行性肾盂内切开术进行分层，钬激光和透热疗法的总体成功率（平均失败时间）分别为80%（10个月）和53%（21个月）（p = 0.0626）。
本系列中顺行性和逆行性肾盂内切开术的总体成功率在很大程度上似乎是提前期偏倚的一个因素，两者相似到足以推荐基于其相对安全性和较短住院时间的钬激光逆行性肾盂内切开术。
