Madec F-X, Suply E, Luyckx F, Nedelec M, Chowaniec Y, Branchereau J, Le Normand L, Glemain P
Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Service de chirurgie pédiatrique département urologique, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
Prog Urol. 2017 May;27(6):369-374. doi: 10.1016/j.purol.2017.03.002. Epub 2017 Apr 1.
The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability.
Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system.
Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo>2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases.
Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted.
本研究的目的是评估软性输尿管肾镜及激光碎石术治疗患有包括严重运动功能障碍在内的神经系统疾病的上尿路结石患者的有效性及发病率。
2006年至2013年期间，我们回顾性分析了83例采用软性输尿管肾镜治疗42例患者的63个肾脏的情况。结石清除（SF）的肾脏定义为在计算机断层扫描、肾脏超声、X线或直接输尿管肾镜检查中未发现结石，被视为手术成功。并发症根据Clavien-Dindo系统进行分类。
首次、第二次和第三次软性输尿管肾镜手术后的成功率分别为49.2%、57.1%和58.7%。在涉及小于20mm结石的病例中，一次手术后的结石清除率为64.3%。未描述有严重并发症（Clavien-Dindo>2）（0%）。并发症发生率为44.7%，Clavien-Dindo 2级的发生率为31.6%。主要并发症是尿脓毒症，发生率为27.6%。
与总体人群相比，软性输尿管肾镜及激光碎石术治疗患有严重运动功能障碍的神经系统疾病患者的上尿路结石成功率较低，且有一些常见的轻度并发症。在临床实践中，这些患者采用软性输尿管肾镜的适应证似乎有限。
5级。
