Department of Urology, Goztepe Training and Research Hospital, Istanbul, Turkey.
J Endourol. 2012 Aug;26(8):983-7. doi: 10.1089/end.2011.0664. Epub 2012 Mar 26.
The development of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract. We compared the use of semirigid and flexible ureteroscopy for the management of shockwave lithotripsy-refractory, isolated renal pelvic calculi by evaluating stone-free rates, operating room times, and associated complications.
Ureteroscopic stone treatment was attempted in 47 patients with isolated renal pelvic stones between November 2008 and December 2010. The procedures were performed under general anesthesia. Semirigid ureteroscopy was routinely performed in all patients. If the stones were accessible in the renal pelvis with the semirigid ureteroscope (S-URS), they were then treated with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser through S-URS under direct vision. If the stones were not accessible, flexible ureteroscopy was then performed. Preoperative, operative, and postoperative data were retrospectively analyzed.
In 25 of 47 patients, renal pelvic stones were accessible with S-URS, and the stones were fragmented with the Ho:YAG laser using S-URS. In the remaining 22 patients, the stones were accessed with the flexible ureteroscope (F-URS), and the fragmentation of stones was performed with the Ho:YAG laser using the F-URS. There were no significant differences in age, body mass index, grade of hydronephrosis, mean stone size, and stone laterality among the two groups. The mean operative times were 71.90 ± 17.90 minutes in the S-URS group and 93.41 ± 18.56 minutes in the F-URS group (P=0.001). The stone-free rates at postoperative day 1 and at the 1 month follow-up were 72% and 76% in the S-URS group and 81.8% and 86.4% in the F-URS group, respectively (P=0.861 and P=0.368). We found no significant differences among groups with regard to stone-free rates, complication rates, and hospital lengths of stay.
Although it is well known that flexible ureteroscopy permits a detailed caliceal examination and therapeutic interventions, semirigid ureteroscopy is also often another sufficient means of reaching the renal pelvis in selected patients.
半刚性和软性输尿管镜的发展使人们更容易进入整个泌尿道的结石。我们通过评估无结石率、手术室时间和相关并发症，比较了半刚性和软性输尿管镜治疗冲击波碎石术难治性孤立肾盂结石的效果。
2008 年 11 月至 2010 年 12 月，我们对 47 例孤立性肾盂结石患者进行了输尿管镜取石治疗。这些程序是在全身麻醉下进行的。所有患者均常规行半刚性输尿管镜检查。如果半刚性输尿管镜（S-URS）可进入肾盂中的结石，则直视下用钬：钇-铝-石榴石（Ho：YAG）激光治疗结石。如果结石无法进入，则进行软性输尿管镜检查。回顾性分析了术前、术中和术后数据。
在 47 例患者中，25 例肾盂结石可通过 S-URS 进入，且使用 S-URS 用 Ho：YAG 激光将结石粉碎。在其余 22 例患者中，使用软性输尿管镜（F-URS）进入肾盂，并用 F-URS 中的 Ho：YAG 激光将结石粉碎。两组患者的年龄、体重指数、肾积水程度、平均结石大小和结石侧位无显著差异。S-URS 组的平均手术时间为 71.90±17.90 分钟，F-URS 组为 93.41±18.56 分钟（P=0.001）。S-URS 组术后第 1 天和第 1 个月的无结石率分别为 72%和 76%，F-URS 组分别为 81.8%和 86.4%（P=0.861 和 P=0.368）。我们发现两组在无结石率、并发症发生率和住院时间方面无显著差异。
尽管众所周知软性输尿管镜可以进行详细的肾盏检查和治疗干预，但在选择的患者中，半刚性输尿管镜也是到达肾盂的另一种有效方法。
