1 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .
2 Department of Urology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania.
J Endourol. 2018 Jul;32(7):603-607. doi: 10.1089/end.2018.0069. Epub 2018 Jun 6.
Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports.
A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated.
We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor.
Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.
输尿管镜设计和附件仪器的进步使得更具挑战性的病例能够通过输尿管镜治疗。在这里，我们评估了我们在处理大肾结石（≥2cm）方面的输尿管镜治疗经验，并对最近的报告进行了简要回顾。
对 2004 年至 2014 年间在单一学术三级保健机构由腔内泌尿科医生团队进行的所有输尿管镜检查病例进行了回顾性分析。我们确定了至少有一个≥2cm 的结石通过逆行输尿管镜治疗的患者。结石大小定义为索引结石的最大线性直径。小直径输尿管镜主要与钬激光一起使用。评估了患者的人口统计学、手术过程中的数据和术后结果。
我们评估了 167 例连续接受输尿管镜检查治疗≥2cm 大肾结石的患者。选择输尿管镜的最初原因包括患者的偏好（29.5%）、其他治疗失败（8.2%）、解剖学考虑/体型（30.3%）和合并症（28.8%）。患者平均年龄为 55.5 岁（22-84 岁）。结石平均大小为 2.75cm，每位患者平均手术次数为 1.65 次（1-6 次）。单次治疗结石清除率为 57.1%，两阶段手术结石清除率为 90.2%，三阶段手术结石清除率为 94.0%。47%的患者使用了通道鞘。结石大小与患者结局之间存在关联；较小的结石与手术次数减少相关。术后并发症轻微。
单阶段或多阶段逆行输尿管镜碎石术是治疗大肾结石的安全有效的手术方式。结石总负荷是分期手术的需要和结石清除率的可靠预测指标。
