Kartal Ibrahim, Tuygun Can, Karakoyunlu Ahmet Nihat, Sandikci Fatih, Baylan Burhan, Ersoy Hamit
Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, 06110, Turkey.
Urol J. 2019 Dec 24;16(6):541-546. doi: 10.22037/uj.v0i0.5205.
This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) andstone disease.
Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated.
The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate.
RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.
本研究旨在评估逆行肾盂内切开术（rLEP）后逆行肾内手术（RIRS）治疗输尿管肾盂连接部梗阻（UPJO）合并结石病的有效性和安全性。
纳入在我院首先接受rLEP治疗梗阻，随后接受RIRS治疗结石病的UPJO合并肾结石患者。研究时间为2012年至2017年。rLEP后最早在第6周进行RIRS。根据倾向评分，将接受rLEP的患者与解剖结构正常的患者按1:1比例进行匹配。此外，比较临床结果以评估rLEP手术对RIRS的影响。随后，对rLEP后接受RIRS的患者进行独立评估，并调查影响序贯手术成功的因素。
rLEP后接受RIRS的患者（n = 27）与接受RIRS的解剖结构正常的对照组之间的唯一差异在于手术时间（p = 0.011）。对序贯rLEP - RIRS组潜在成功因素的评估显示，原发性病因、梗阻长度小于1cm、结石尺寸较小和单发性结石具有显著影响（分别为p = 0.047、p = 0.030、p = 0.040、p < 0.001）。rLEP后RIRS的结石清除率为81. %，中位随访时间32个月后，梗阻解除率为74.1%。
UPJO合并肾结石患者rLEP后行RIRS是一种有效的治疗方法。它可安全用于单发结石<2cm、梗阻长度短且存在原发性病因的患者。
