Humphreys Mitchell R, Miller Nicole L, Williams James C, Evan Andrew P, Munch Larry C, Lingeman James E
International Kidney Stone Institute, Clarian/Methodist Hospital, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
J Urol. 2008 Mar;179(3):970-5. doi: 10.1016/j.juro.2007.10.073. Epub 2008 Jan 22.
The latest digital ureteroscope, the DUR-D (Gyrus ACMI Inc., Southborough, Massachusetts) offers image quality that greatly exceeds current analog image capabilities. The purpose of this report was to document the applicability of this device in studying the earliest stages of stone formation.
Symptomatic patients with nephrolithiasis (less than 1 cm in diameter) were prospectively enrolled and their renal papilla digitally mapped prior to stone removal. Recovered stones were photographed and analyzed using micro-computerized tomography. If the procedure could not be completed with the DUR-D, a conventional ureteroscope was used. Minors, pregnant patients and those with systemic disorders were excluded.
Eight patients (10 renal units), 2 cystine and 6 calcium oxalate stone formers, were studied with a mean age of 50.1 years. Excellent images were collected for all papilla except in 2 cases; a proximal ureteral stricture and acute angulation of the lower pole collecting system, respectively. There were no mechanical device failures. Of the 10 renal units 7 had stents postoperatively and there were no patient complications.
The ease of use and high quality images of digital ureterorenoscopy will allow the documentation of the earliest stages of calcium oxalate stone formation and, thereby, advance our understanding of the pathogenesis of calcium oxalate stone formation.
最新的数字输尿管镜DUR-D（美国马萨诸塞州南borough市的Gyrus ACMI公司）提供的图像质量大大超过了当前模拟图像的能力。本报告的目的是记录该设备在研究结石形成最早阶段的适用性。
前瞻性纳入有症状的肾结石患者（直径小于1厘米），在取石术前对其肾乳头进行数字绘图。对取出的结石进行拍照，并使用微型计算机断层扫描进行分析。如果使用DUR-D无法完成该操作，则使用传统输尿管镜。排除未成年人、孕妇和患有全身性疾病的患者。
研究了8例患者（10个肾单位），其中2例为胱氨酸结石形成者，6例为草酸钙结石形成者，平均年龄为50.1岁。除2例情况外，所有乳头均收集到了优质图像；这2例分别为近端输尿管狭窄和下极集合系统急性成角。没有机械装置故障。10个肾单位中有7个术后放置了支架，且没有患者出现并发症。
数字输尿管肾镜的易用性和高质量图像将有助于记录草酸钙结石形成的最早阶段，从而推进我们对草酸钙结石形成发病机制的理解。
