Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany.
Curr Opin Urol. 2019 Mar;29(2):129-134. doi: 10.1097/MOU.0000000000000571.
To summarize the recent literature on the topic of residual stone fragments in particular novel developments in this field.
The urological position towards residual fragments has shifted in recent years from observation, to active retrieval with innovative methods, to algorithm-based predictions of surgical outcomes. Novel technologies have been described to extract residual fragments through magnetism, a polyethylene endoscopic pouch and a biocompatible stone adhesive. In an effort to have a tighter grip over the outcome of residual fragments, artificial neural networks (ANNs) have been developed to accurately predict surgical outcomes in terms of stone clearance and secondary procedures.
Growing evidence continues to show the term clinically insignificant residual fragments (CIRF) for residual fragments of 4 mm or less to be a misnomer. In fact, only a third of CIRF is spontaneously cleared from the kidney after surgery and may become a cause for reintervention being both costly and significantly affecting patients' well being. Several novel methods which have been developed to extract residual fragments require further in-vivo investigations to confirm their safety and efficacy. ANNs algorithms are increasingly being used to predict surgical outcomes in stone therapy and assist in preoperative patient counselling and decision-making.
总结近年来关于残余结石碎片的文献，特别是该领域的新进展。
近年来，泌尿外科医生对残余结石碎片的态度已经从观察转变为积极地使用创新方法进行清除，再到基于算法预测手术结果。已经有新的技术被描述用于通过磁性、聚乙烯内镜袋和生物相容性结石粘合剂来提取残余碎片。为了更好地控制残余碎片的结果，已经开发出人工神经网络 (ANNs) 来准确预测结石清除和二次手术等方面的手术结果。
越来越多的证据表明，残余结石碎片小于或等于 4 毫米的“临床无意义残余碎片”（CIRF）这个术语是不准确的。实际上，只有三分之一的 CIRF 在手术后会自发从肾脏中排出，可能会导致再次干预，这既昂贵又会严重影响患者的生活质量。已经开发出几种新的方法来提取残余碎片，需要进一步的体内研究来确认其安全性和有效性。ANNs 算法越来越多地用于预测结石治疗的手术结果，并有助于术前患者咨询和决策制定。
