Ramón de Fata F, Hauner K, Andrés G, Angulo J C, Straub M
Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Múnich, Alemania.
Actas Urol Esp. 2015 Sep;39(7):442-50. doi: 10.1016/j.acuro.2014.09.003. Epub 2015 Feb 7.
Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) are consolidated procedures for the treatment of kidney stones; however, their primary weak points are the lower efficacy of ESWL, especially for lower calyx stones, and the morbidity of PCNL resulting from the creation and dilation of the percutaneous trajectory. The increasing miniaturization of percutaneous surgery instrumentation and the development of retrograde intrarenal surgery (RIRS) are recent innovations.
A structured nonsystematic review was conducted through a literature search of articles published between 1997 and 2013, using the terms kidney stones, miniperc, mini-PCNL, RIRS and flexible ureteroscopy in the PubMed, Google Scholar and Scopus databases.
RIRS requires greater surgical time, several procedures for voluminous stones and higher hospital costs, due in part to the relative fragility of the instruments. On the other hand, miniperc requires a longer hospital stay, an increased need for postoperative analgesia and a greater reduction in hemoglobin levels, although these do not translate into an increased rate of transfusions.
The current treatment of kidney stones uses minimally invasive procedures such as miniperc and RIRS. The 2 procedures are equivalent in terms of efficacy (stone clearance) and are associated with minimal complications. Comparative prospective studies are necessary to determine the position of each of these techniques in the treatment of kidney stones. In our experience, the 2 techniques are complementary and should be part of the current urological therapeutic arsenal.
体外冲击波碎石术（ESWL）和经皮肾镜取石术（PCNL）是治疗肾结石的成熟方法；然而，它们的主要缺点是ESWL疗效较低，尤其是对下盏结石，以及PCNL因经皮通道的建立和扩张导致的发病率。经皮手术器械的日益小型化和逆行肾内手术（RIRS）的发展是近期的创新。
通过在PubMed、谷歌学术和Scopus数据库中检索1997年至2013年发表的文章，使用肾结石、迷你经皮肾镜、微型PCNL、RIRS和软性输尿管镜等术语，进行了结构化的非系统综述。
RIRS需要更长的手术时间、对体积较大的结石进行多次手术以及更高的住院费用，部分原因是器械相对脆弱。另一方面，迷你经皮肾镜需要更长的住院时间、术后镇痛需求增加以及血红蛋白水平下降幅度更大，尽管这些并未转化为输血率的增加。
目前肾结石的治疗采用微创方法，如迷你经皮肾镜和RIRS。这两种方法在疗效（结石清除率）方面相当，且并发症最少。需要进行比较性前瞻性研究来确定这些技术在肾结石治疗中的地位。根据我们的经验，这两种技术是互补的，应成为当前泌尿外科治疗手段的一部分。
