Porpiglia Francesco, Fiori Cristian, Poggio Massimiliano, Cossu Marco, Amparore Daniele, Manfredi Matteo, Bertolo Riccardo, Mele Fabrizio, Garrou Diletta, Cattaneo Giovanni, Scarpa Roberto Mario
Divisione di Urologia, Dipartimento di Oncologia, Ospedale San Luigi Gonzaga, Orbassano (TO) - Italy.
Urologia. 2014 Apr-Jun;81(2):99-107. doi: 10.5301/uro.5000076. Epub 2014 Jun 10.
Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in '80s many technological improvements allowed to reduce endourological instruments' size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.
在过去40年里，尿石症的治疗从开放手术疗法转向了微创方法。自20世纪80年代首次引入输尿管镜以来，许多技术改进使得腔内泌尿外科器械的尺寸得以减小，同时确保了尿石症治疗的成功率不断提高。本研究的目的是回顾输尿管镜检查（URS）在尿路结石治疗中的当前作用。我们参考最新指南和文献结果进行了非系统性综述。结果证实，对于输尿管结石，在治疗远端输尿管结石<10mm和>10mm时，URS的结石清除率（SFR）显著高于体外冲击波碎石术（ESWL）。在内镜检查在治疗近端输尿管结石>10mm时也与ESWL一样具有一线作用。接受URS治疗的患者的再次治疗率和辅助程序也较低，尽管与ESWL相比，URS的侵入性更强。文献中已有关于逆行肾内手术（RIRS）治疗肾结石的最新数据。RIRS是治疗<20mm结石的一线治疗方法，与ESWL一起，对于>20mm的结石则是第二选择。然而，对于大型肾结石，RIRS的作用仍在讨论中。总之，大多数尿路结石可以通过硬性或软性URS进行治疗。需要进一步研究以明确内镜检查在大型结石治疗中的作用，特别是与经皮治疗方法相比时。
