Department of Urology, Klinikum Sindelfingen-Boeblingen Medical Center, University of Tübingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany.
World J Urol. 2011 Dec;29(6):755-9. doi: 10.1007/s00345-011-0784-y. Epub 2011 Oct 29.
The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10-30 mm size.
fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed.
Patients' demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III-V) occured in both groups.
Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.
软性输尿管镜检查术（fURS）和微创经皮肾镜取石术（mPNL）在较大肾结石中的应用价值存在争议。本非随机前瞻性研究旨在评估 fURS 和 mPNL 治疗大小为 10-30mm 的孤立肾结石的效果。
对 21 例采用最新一代 7.5F 输尿管镜进行 fURS 的患者进行研究。19 例患者使用输尿管接入鞘。25 例患者采用 18F 改良 Amplatz 鞘联合 14F 肾镜行 mPNL。该手术可经顺行支架或肾造口无管化进行，也可进行 Tubeless 处理。评估两种手术的效果和并发症。
患者的人口统计学特征和结石大小相当（18±5mm 比 19±4mm，P=0.08）。fURS 组患者的平均 BMI 较高（31 比 27，P＜0.05）。fURS 的总手术时间明显更长（106±51 比 59±19min，P＜0.001）。单次经皮治疗后无结石残留的患者比例更高，而需要进行 2 期 fURS 治疗的患者比例较高（总手术次数 1.04 比 1.52，P＜0.001；即刻无石率（SFR）96%比 71.5%，P＜0.001）。4 周时的 SFR 为 100%（mPNL）和 85.8%（fURS）（P＜0.01）。Clavien I 或 II 级别的轻微并发症分别发生在 16%和 23.8%的 mPNL 和 fURS 患者中（P=0.13）。两组均未发生 III-V 级主要并发症。
我们的研究结果支持对肾结石采用经皮或逆行内镜治疗的概念，两种方法都具有很好的安全性。然而，fURS 需要进行更高比例的 2 期手术，而 mPNL 则可实现更快、更高的 SFR，同时不增加并发症发生率。
