Traxer Olivier, Letendre Julien
Urology Department, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, Paris Cedex 20, 75970, France,
World J Urol. 2014 Jun;32(3):715-21. doi: 10.1007/s00345-013-1138-8. Epub 2013 Aug 3.
To evaluate the feasibility and usefulness of extracorporeal lithotripsy endoscopically controlled by simultaneous flexible ureterorenoscopy (LECURS) and combined with Holmium laser lithotripsy for kidney stones surgery.
Retrograde flexible ureteroscopy allowed stone visualization and intrarenal relocation when possible. Extracorporeal schock wave lithotripsy (ESWL) was performed under direct vision allowing constant focal zone adjustment for optimal stone fragmentation. Holmium laser lithotripsy was used simultaneously when necessary. Post-operative assessment included ultrasound at day one and abdominal CT scan 3 weeks later to evaluate for residual fragments.
Six patients with kidney stones were recruited including 3 with relative contraindication to ESWL. One patient had a stone beyond an infundibular stenosis and 2 had multiple stones in a horseshoe kidney with an uretero-pelvic junction (UPJ) stricture. A 100 % stone fragmentation rate was obtained. Post-operative ultrasound was normal in 5 patients and showed slight peri-renal infiltration in the other. One patient developed an obstructive pyelonephritis requiring antibiotics and changing a double J to a ureteral catheter. No other complications were noted. Three patients (50 %) were stone free after LECURS. Three patients underwent a second-look procedure for small (<3 mm) retained residual fragments. No damage was seen with the digital ureteroscopes, laser fibers or stone baskets.
This initial experience with LECURS has shown to be feasible and safe. This opens the opportunity for further evaluation of this approach in order to improve outcomes of both approaches.
评估经皮肾镜碎石术在软性输尿管肾镜同步内镜控制下（LECURS）并联合钬激光碎石术用于肾结石手术的可行性和实用性。
逆行软性输尿管镜检查尽可能实现结石可视化及肾内重新定位。在直视下进行体外冲击波碎石术（ESWL），可不断调整聚焦区以实现最佳结石破碎效果。必要时同时使用钬激光碎石术。术后评估包括术后第1天的超声检查及3周后的腹部CT扫描，以评估残留碎片情况。
招募了6例肾结石患者，其中3例有ESWL相对禁忌证。1例患者的结石位于肾盂漏斗部狭窄远端，2例马蹄肾患者有多发结石且伴有输尿管肾盂连接部（UPJ）狭窄。结石破碎率达100%。5例患者术后超声检查正常，另1例显示肾周有轻微浸润。1例患者发生梗阻性肾盂肾炎，需要使用抗生素并将双J管更换为输尿管导管。未发现其他并发症。3例患者（50%）在LECURS术后结石清除。3例患者因残留小结石碎片（<3 mm）接受了二次手术。未发现电子输尿管镜、激光光纤或结石篮受损。
LECURS的初步经验表明该方法可行且安全。这为进一步评估该方法以改善两种方法的治疗效果提供了机会。
