Department of Urology, University of California Irvine (UCI), 333 City Blvd West, Suite 2100, Orange, Irvine, CA, 92868, USA.
Department of Urology, Hospital Pablo Tobon Uribe (HPTU), Medellin, Colombia.
World J Urol. 2018 Jun;36(6):963-969. doi: 10.1007/s00345-018-2223-9. Epub 2018 Feb 8.
Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion.
After a pretreatment week of tamsulosin 0.4 mg/day (one center only) and following a documented sterile urine, a total of ten patients underwent retrograde holmium laser-assisted endoscopic-guided nephrostomy access in a prone split leg position.
In nine of ten patients, ureteroscopic guided, holmium laser access via an upper pole posterior calyx was achieved. In one patient, the laser tract could not be safely dilated and antegrade endoscopic and fluoroscopic guided access was performed. The mean operative time was 202 min; the mean fluoroscopy time was 32 s (6/9 cases). The mean pre-operative stone volume was 14,420 mm. CT imaging on post-operative day 1 revealed 6/6 patients had residual stone fragments with total mean volume of 250 mm (96% reduction); there were no residual fragments in three patients who were evaluated with non-CT radiographic imaging (KUB). There was a single complication requiring angioembolization due to a subcapsular hematoma with associated secondary tearing of an inter-polar vessel remote from the nephrostomy site.
Holmium laser-assisted endoscopic-guided retrograde access in a prone split-leg position was successfully performed at two institutions. The accuracy of nephrostomy placement and lessening of fluoroscopy time are two potential benefits of this approach.
经皮肾镜取石术仍然是一项具有挑战性的手术，主要是因为获得通道困难。实际上，由于使用透视或超声逆行穿刺技术困难，很少有泌尿科医生获得自己的通道。在此，我们报告首次使用钬激光能量逆行获得通道的经验。
在接受坦索罗辛 0.4mg/天的预处理周（仅一个中心）并获得无菌尿液后，共有 10 名患者在俯卧分腿位接受逆行钬激光辅助内镜引导经皮肾造瘘术。
在 10 名患者中的 9 名中，通过上极后盏输尿管镜引导，成功实现了钬激光通道。在 1 名患者中，激光通道不能安全扩张，因此进行了逆行内镜和透视引导的通道。平均手术时间为 202 分钟；平均透视时间为 32 秒（6/9 例）。术前结石体积平均为 14420mm。术后第 1 天的 CT 成像显示 6/6 名患者仍有结石碎片，总平均体积为 250mm（96%减少）；在 3 名接受非 CT 影像学检查（KUB）的患者中无残留碎片。有 1 例并发症需要血管栓塞治疗，原因是包膜下血肿伴肾造瘘部位附近的一个极间血管二次撕裂。
在两个机构成功地进行了俯卧分腿位钬激光辅助内镜引导逆行通道。这种方法的两个潜在优势是经皮肾造瘘位置的准确性和透视时间的减少。
