Vilches R M, Aliaga A, Reyes D, Sepulveda F, Mercado A, Moya F, Ledezma R, Hidalgo J P, Olmedo T, Marchant F
Departamento de Urología, Hospital Clínico Universidad de Chile, Santiago, Chile.
Departamento de Urología, Hospital Clínico Universidad de Chile, Santiago, Chile.
Actas Urol Esp. 2015 May;39(4):236-42. doi: 10.1016/j.acuro.2014.08.003. Epub 2014 Nov 28.
Extracorporeal Shock Wave Lithotripsy (ESWL) is currently the recommended treatment for intra-renal calculi smaller than 2 cm. However the low Stone Free Rate (SFR) in lower pole calculi gives rise to new techniques, such us retrograde intrarenal surgery (RIRS), for improve the surgery outcomes.
To compare the efficacy of a treatment with ESWL with RIRS, in terms of SFR after surgery, in patients with kidney stones up to 15 mm in the lower pole.
A prospective study was carried out in order to assess the results of ESWL and RIRS in patients with lower pole stones less than 15 mm. Among a total of 55 patients, 31 were underwent to ESWL (Group 1) and the remaining 24 to RIRS (Group 2). Clinical data recorded, including general characteristics of each patient, were: calculi size, side, operative time, complications according to Clavien scale, SFR and the presence of residual fragments at 2 months post-treatment assessed by a CT scan. STATA 11 was used to perform the statistical analysis.
There were no differences for general descriptors among groups with the exception of a significantly longer operative time for RIRS. The rates of SFR and residual fragments lesser than 3 mm. were lower in the RIRS group than in ESWL ones. RIRS also showed a lower rate of clinically significant fragments (0% vs 42.3%. P < .05). In the subgroup of patients with stones between 10/15 mm RIRS showed higher SFR (75% vs. 41.2%) and a lower rate of stones>3 mm (0% vs. 58.8%), being statistically significant (P < .05). Clavien III or higher complications were not reported in any of the groups.
In the treatment of lower pole stone RIRS has the same results than ESWL in terms of SFR. Regarding absence of a clinically significant residual fragment, RIRS was superior to ESWL. A bigger sample size is required in order to confirm this results.
体外冲击波碎石术（ESWL）目前是治疗小于2 cm的肾内结石的推荐方法。然而，下极结石的低无石率（SFR）催生了新技术，如逆行肾内手术（RIRS），以改善手术效果。
比较ESWL与RIRS治疗下极直径达15 mm肾结石患者术后SFR的疗效。
开展一项前瞻性研究，以评估ESWL和RIRS治疗下极结石小于15 mm患者的结果。在总共55例患者中，31例接受ESWL治疗（第1组），其余24例接受RIRS治疗（第2组）。记录的临床数据包括每位患者的一般特征，有：结石大小、部位、手术时间、根据Clavien分级的并发症、SFR以及治疗后2个月通过CT扫描评估的残留碎片情况。使用STATA 11进行统计分析。
除RIRS手术时间明显更长外，各组间一般描述指标无差异。RIRS组的SFR和小于3 mm的残留碎片率低于ESWL组。RIRS还显示出临床显著碎片率较低（0%对42.3%，P < 0.05）。在结石为10/15 mm的患者亚组中，RIRS显示出更高的SFR（75%对41.2%）和更低的大于3 mm结石率（0%对58.8%），具有统计学意义（P < 0.05）。两组均未报告Clavien III级或更高等级的并发症。
在下极结石治疗中，RIRS在SFR方面与ESWL效果相同。在无临床显著残留碎片方面，RIRS优于ESWL。需要更大样本量以证实该结果。
