Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
BJU Int. 2012 May;109(9):1384-9. doi: 10.1111/j.1464-410X.2011.10691.x. Epub 2011 Oct 28.
Study Type--Therapy (case control). Level of Evidence 3b. What's known on the subject? and What does the study add? Recently European Association of Urology 2011 guidelines on urolithiasis recommended retrograde intrarenal surgery as the second-line therapy for the treatment of kidney stones <10 mm in diameter. This study shows that retrograde intrarenal surgery may be an alternative therapy to percutaneous nephrolithotomy, with acceptable efficacy and low morbidity for 2-4 cm stones.
• Currently, the indications for retrograde intrarenal surgery (RIRS) have been extended due to recent improvements in endoscopic technology. In this study, we compare the outcomes of percutaneous nephrolithotomy (PCNL) and RIRS in the treatment of 2-4 cm kidney stones.
• Between September 2008 and January 2011, 34 patients who had renal stones ranging from 2 to 4 cm in diameter were treated with RIRS. The outcomes of these patients were compared with patients who underwent PCNL using matched-pair analysis (1:1 scenario). • The matching parameters were the size, number and location of the stones as well as age, gender, body mass index, solitary kidney, degree of hydronephrosis, presence of previous shock wave lithotripsy and open surgery. • Data were analysed using Fisher's exact test, Student's t test and the Mann-Whitney U test.
• Stone-free rates after one session were 73.5% and 91.2% for RIRS and PCNL respectively (P= 0.05). Stone-free rate in the RIRS group improved to 88.2% after the second procedure. • Mean operation duration was 58.2 (±) 13.4 min in the RIRS group but 38.7 (±) 11.6 min in the PCNL group (P < 0.0001). Blood transfusions were required in two patients in the PCNL group. • Overall complication rates in the PCNL group were higher, but the differences were not statistically significant. Hospitalization time was significantly shorter in the RIRS group (30.0 + 37.4 vs 61.4 + 34.0 h, respectively; P < 0.001).
• Satisfactory outcomes can be achieved with multi-session RIRS in the treatment of 2-4 cm renal stones. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones.
目前，由于内镜技术的最新进展，经皮肾镜取石术（PCNL）的适应证已经扩大。在本研究中，我们比较了 PCNL 和 RIRS 治疗 2-4cm 肾结石的疗效。
2008 年 9 月至 2011 年 1 月，34 例肾结石患者，肾结石直径 2-4cm，采用 RIRS 治疗。采用配对分析（1:1 方案）比较这些患者与接受 PCNL 治疗的患者的结果。匹配参数包括结石的大小、数量和位置，以及年龄、性别、体重指数、孤立肾、肾积水程度、既往冲击波碎石术和开放手术史。采用 Fisher 确切检验、Student t 检验和 Mann-Whitney U 检验进行数据分析。
一次 RIRS 和 PCNL 的无石率分别为 73.5%和 91.2%（P=0.05）。RIRS 组第二次手术后无石率提高至 88.2%。RIRS 组的平均手术时间为 58.2（±）13.4min，而 PCNL 组为 38.7（±）11.6min（P<0.0001）。PCNL 组有 2 例患者需要输血。PCNL 组的总体并发症发生率较高，但差异无统计学意义。RIRS 组的住院时间明显缩短（分别为 30.0+37.4 和 61.4+34.0h，P<0.001）。
多通道 RIRS 治疗 2-4cm 肾结石可获得满意的疗效。对于较大的肾结石，RIRS 可作为 PCNL 的替代治疗方法。
