Honeck P, Nagele U, Michel M S
Urologische Universitätsklinik Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
Urologe A. 2008 May;47(5):587-90. doi: 10.1007/s00120-008-1735-0.
Endoscopic stone management is a field of consistent technical innovation. For ureterorenoscopy, flexible scopes capable of 270 degrees deflection have allowed access to the complete urinary tract, including the lower-pole renal calculi. To counter the flaw of high repair costs, new-generation flexible ureterorenoscopes feature significantly greater durability and a less frequent need for repair. The development and improvement of auxiliary instruments such as access sheaths has facilitated the procedures, reduced complications, and improved the stone-free rates. A similar trend is seen for percutaneous nephrolitholapaxy (PCNL). Development is directed at miniaturised instruments such as the mini-PCNL. Especially in combination with a tubeless procedure in which a routine nephrostomy after PCNL is omitted and the nephrostomy tract is closed using hemostyptic sealant, similar success rates are achieved, with fewer complications and shorter hospital stays.
内镜下结石治疗是一个技术不断创新的领域。对于输尿管肾镜检查,可进行270度偏转的软性内镜能够进入整个尿路,包括下极肾结石。为了应对高昂维修成本的缺陷,新一代软性输尿管肾镜具有显著更高的耐用性,维修需求也更少。诸如通道鞘等辅助器械的开发和改进简化了操作,减少了并发症,并提高了结石清除率。经皮肾镜取石术(PCNL)也呈现出类似的趋势。其发展方向是小型化器械,如迷你PCNL。特别是与无管化手术相结合,即PCNL术后省略常规肾造瘘,使用止血密封剂封闭肾造瘘通道,可取得相似的成功率,并发症更少,住院时间更短。