Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
Urolithiasis. 2020 Jun;48(3):263-270. doi: 10.1007/s00240-019-01150-0. Epub 2019 Aug 1.
Controversies exist on the influence of lower pole anatomy (infundibular pelvic angle, IPA; infundibular length, IL; and infundibular width, IW) for success and outcomes related to the treatment of stones in the lower pole. We wanted to look at the role of lower pole anatomy to study clinical outcomes in patients treated for isolated lower pole stones (LPS) using retrograde intra renal surgery (RIRS), and also perform a review to look at the published literature on the influence of pelvicalyceal anatomy on success with RIRS. Data were prospectively collected (June 2013-June 2016) for all patients who underwent RIRS for LPS, and the imaging was then retrospectively reviewed to calculate the IPA, IL and IW using the Elbahnasy method. A systematic review was also conducted for all English language articles between January 2000 and April 2018, reporting on the impact of pelvicaliceal anatomy on RIRS. A total of 108 patients with LPS were included with a male to female ratio of 2:3 and a mean age of 54.7 years. The mean lower pole stone size was 9.3 mm (range 3-29 mm) and 102/108 (94.4%) patients were stone free (SF) at the end of their procedure. While steep IPA (< 30°), operative time duration and larger stone size were significant predictors of failure, the placement of ureteric access sheath, IW and IL did not influence treatment outcomes. Six studies (460 patients) met the inclusion criteria for our review. The IPA, IW, IL for failure ranged from 26° to 38°, 5.5-7 mm and 24-34 mm, respectively. The SFR ranged from 78 to 88% with a metaanalysis showing IPA as the most important predictor of treatment outcomes for LPS. Infundibular pelvic angle seems to be the most important predictor for the treatment of LPS using RIRS. Pelvicalyceal anatomy in conjunction with stone size and hardness seem to dictate the success, and decisions on the type of surgical interventions should reflect this.
关于下极解剖结构（漏斗骨盆角 IPA、漏斗长度 IL 和漏斗宽度 IW）对治疗下极结石的成功率和结果的影响存在争议。我们希望观察下极解剖结构在使用逆行肾内手术 (RIRS) 治疗孤立性下极结石 (LPS) 患者的临床结果中的作用，并回顾分析已发表的文献，以了解肾盂肾盏解剖结构对 RIRS 成功率的影响。从 2013 年 6 月至 2016 年 6 月，前瞻性收集所有接受 LPS 行 RIRS 治疗的患者的数据，然后回顾性分析影像资料，采用 Elbahnasy 方法计算 IPA、IL 和 IW。还对 2000 年 1 月至 2018 年 4 月间所有发表的英文文章进行了系统综述，报告肾盂肾盏解剖结构对 RIRS 的影响。共纳入 108 例 LPS 患者，男女比例为 2:3，平均年龄为 54.7 岁。下极结石平均大小为 9.3mm（范围 3-29mm），108/108（94.4%）例患者在手术结束时结石清除（SF）。虽然 IPA 陡峭（<30°）、手术时间和较大的结石大小是失败的显著预测因素，但输尿管进入鞘的放置、IW 和 IL 并不影响治疗结果。我们的综述共纳入了 6 项研究（460 例患者）。失败患者的 IPA、IW、IL 分别为 26°至 38°、5.5-7mm 和 24-34mm。SFR 为 78%至 88%，荟萃分析表明 IPA 是 LPS 治疗结果的最重要预测因素。IPA 似乎是使用 RIRS 治疗 LPS 的最重要预测因素。肾盂肾盏解剖结构与结石大小和硬度一起决定了治疗的成功，手术干预类型的决策应反映这一点。
