Manikandan Ramanitharan, Mittal Jayesh Kumar, Dorairajan Lalgudi Narayanan, Mishra Amit Kumar, Sreerag Kodakkatil Sreenivasan, Verma Anil
Department of Urology, JIPMER , Puducherry, India .
J Endourol. 2016 Oct;30(10):1056-1061. doi: 10.1089/end.2016.0329. Epub 2016 Sep 13.
The management of simultaneous renal and ureteral calculi usually require staged procedure or change of position from supine lithotomy for ureterorenoscopic lithotripsy to prone for conventional percutaneous nephrolithotomy (PCNL). We review our experience with endoscopic combined intrarenal surgery (ECIRS) in the management of this condition.
A total of 43 patients with simultaneous renal and ureteral calculi underwent ECIRS in Galdakao-modified supine Valdivia (GMSV) position from June 2012 to March 2016. Relevant demographic and clinical data were analyzed retrospectively. Clinical outcomes such as stone-free rate, complications, and hospital stay were evaluated. Factors predicting stone-free rate were also evaluated.
The mean ureteral stone size was 9.79 ± 2.11 mm and the mean renal stone size was 28.0 ± 11.4 mm. All patients with ureteral calculus were stone free after first intervention. The overall immediate renal stone success rate was 81.4%, which increased to 97% after auxiliary procedure. The overall complication rate was 32.5% with majority of complications (86%) classified under Clavien grade 1 and 2. Two patients had Clavien grade 3 complication with no grade 4 or 5 complications. The mean operative room occupation time was 132.09 ± 35.3 minutes. The median hospital stay was 6 days (range: 2-31). On analyzing for risk factors, only the number of involved calices by stone was significantly associated with stone-free rate following ECIRS (p = 0.03).
ECIRS is a novel and excellent approach for the treatment of simultaneous renal and ureteral calculi with stone clearance and morbidity profile comparable to traditional prone PCNL. We believe that the advantage provided by this approach to the surgeon, patient, and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.
同时处理肾和输尿管结石通常需要分期手术，或从仰卧位截石位转换为俯卧位，以便进行输尿管肾镜碎石术和传统经皮肾镜取石术（PCNL）。我们回顾了我们在内镜联合肾内手术（ECIRS）治疗这种情况方面的经验。
2012年6月至2016年3月，共有43例同时患有肾和输尿管结石的患者在加尔达考改良仰卧位瓦尔迪维亚（GMSV）体位下接受了ECIRS。对相关人口统计学和临床数据进行回顾性分析。评估结石清除率、并发症和住院时间等临床结果。还评估了预测结石清除率的因素。
输尿管结石平均大小为9.79±2.11毫米，肾结石平均大小为28.0±11.4毫米。所有输尿管结石患者在首次干预后结石均清除。肾内结石的总体即刻成功率为81.4%，辅助手术后升至97%。总体并发症发生率为32.5%，大多数并发症（86%）属于Clavien 1级和2级。两名患者出现Clavien 3级并发症，无4级或5级并发症。平均手术室占用时间为132.09±35.3分钟。中位住院时间为6天（范围：2 - 31天）。在分析危险因素时，只有结石累及的肾盏数量与ECIRS术后结石清除率显著相关（p = 0.03）。
ECIRS是一种新颖且出色的治疗同时存在的肾和输尿管结石的方法，其结石清除率和发病率与传统俯卧位PCNL相当。我们认为这种方法为外科医生、患者和麻醉师带来的优势可能会导致该技术在复杂尿路结石管理中得到广泛应用。
