Elbir Fatih, Başıbüyük İsmail, Topaktaş Ramazan, Kardaş Sina, Tosun Muhammed, Tepeler Abdulkadir, Armağan Abdullah
Department of Urology, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey.
Clinic of Urology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Turk J Urol. 2015 Sep;41(3):113-8. doi: 10.5152/tud.2015.81488.
In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively.
RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm.
152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p=0.029), stone number (p=0.01), stone location (p=0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients.
With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.
本研究对279例行逆行性肾内手术（RIRS）的患者的手术结果进行回顾性评估。
2011年3月至2015年2月期间，在导丝引导鞘辅助下对279例患者实施RIRS。所有患者均采用标准截石位进行手术。在硬性输尿管肾镜辅助下插入亲水导丝，并检查是否存在残留输尿管结石及其他病变。所有病例均常规使用荧光透视。小于3mm的结石碎片予以留存，而大于3mm的结石碎片在碎石后用抓钳取出。术后1个月通过腹部平片（KUB）、泌尿系统超声（US）和/或计算机断层扫描（CT）对患者进行检查。手术成功率定义为结石清除状态或残留碎片小于3mm。
患者中男性152例，女性127例。男性和女性患者的中位年龄分别为47.7岁（1 - 86岁）和45.9岁（3 - 79岁）。结石中位大小为13.5mm（8 - 25mm）。术前34例（12.1%）患者留置双J输尿管支架。19例（6.8%）患者在仍接受抗血栓和抗血小板治疗时接受手术。24例患者为孤立肾，其余患者分别有脊柱后凸侧弯（n = 3）、旋转异常（n = 6）、盆腔肾（n = 2）、双集合系统（n = 3）和马蹄肾（n = 6）。264例患者使用了引导鞘，15例患者在导丝辅助下进行手术。14例患者因输尿管狭窄插入双J支架，并在2周后接受手术。所有病例中219例患者的肾结石被完全粉碎，患者结石清除后出院（SF）。我们的成功率（结石清除或存在临床意义不显著的残留结石[CIRF]）为78.4%。结石大小（p = 0.029）、结石数量（p = 0.01）、结石位置（p = 0.023）对RIRS术后结石清除率有显著影响。平均手术时间和透视时间分别为62.5分钟（40 - 180分钟）和29.8秒（4 - 96秒）。平均住院时间为26.4小时（12 - 72小时）。253例患者因结石负荷较大和输尿管水肿留置双J支架。除2例患者围手术期发生感染外，所有病例均未观察到任何并发症。
随着激光技术和软性输尿管肾镜的发展，肾结石可以以较低的发病率和较高的成功率进行治疗。
