Palmero J L, Castelló A, Miralles J, Nuño de La Rosa I, Garau C, Pastor J C
Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario La Ribera, Alzira, Valencia, España.
Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario La Ribera, Alzira, Valencia, España.
Actas Urol Esp. 2014 May;38(4):257-62. doi: 10.1016/j.acuro.2013.09.010. Epub 2013 Oct 21.
To analyze the results of retrograde intrarenal surgery (RIRS) in patients with ≥2 cm stones treated in our center.
A retrospective review of 106 patients with renal calculi underwent RIRS ≥2 cm (period January 2009-December 2011). The procedures were performed under general anesthesia as a source of fragmentation using the holmium laser (30 W Litho Quantasystem) and flexible ureteroscopes (X2 Flex Storz, Olympus P5) through ureteral access sheaths. It discusses demographic variables (age, medical history, antiplatelet or anticoagulant treatment, treatment of urolithiasis, BMI, ASA), treated stones variables (size, number, Hounsfield units, biochemical composition) and intra-and postoperative variables (operative time, number of pulses, hospital stay, complications) with the completion of a descriptive analysis of the same. To define our results we consider success to the complete absence of fragments or residual <5 mm posterior imaging tests.
The mean stone size was 2.46 cm treated, being the only stone in 87.7% of cases. The most frequent location was the renal pelvis stones (44%) followed by the lower calyx (39%). The postoperative complication rate was 6.7%, with all of little relevance. The success rate with a single procedure was 79.4% to 94.1% with retreatment.
RIRS is a valid alternative for the treatment of kidney stones ≥2 cm for its high success rate and few complications if performed in specialized centers.
分析在本中心接受治疗的结石≥2 cm患者的逆行性肾内手术（RIRS）结果。
回顾性分析2009年1月至2011年12月期间接受RIRS治疗的106例肾结石≥2 cm患者。手术在全身麻醉下进行，使用钬激光（30 W Litho Quantasystem）和软性输尿管镜（X2 Flex Storz，Olympus P5）通过输尿管鞘作为碎石源。对人口统计学变量（年龄、病史、抗血小板或抗凝治疗、尿路结石治疗、BMI、ASA）、治疗结石变量（大小、数量、亨氏单位、生化成分）以及术中和术后变量（手术时间、脉冲数、住院时间、并发症）进行讨论，并对其进行描述性分析。为确定我们结果，若术后影像检查完全无碎片或残留<5 mm，则视为成功。
治疗的结石平均大小为2.46 cm，87.7%的病例为单发结石。最常见的部位是肾盂结石（44%），其次是下盏（39%）。术后并发症发生率为6.7%，所有并发症相关性均较小。单次手术成功率为79.4%，再次治疗后成功率为94.1%。
RIRS对于治疗≥2 cm肾结石是一种有效的替代方法，因为其成功率高，且在专业中心进行时并发症少。
