Sakhaei Shahrokh, Fallah-Karkan Morteza, Razzaghi Mohammadreza, Kazemzadeh Azad Babak, Aliakbari Fereshteh
Urology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Lasers Med Sci. 2019 Fall;10(Suppl 1):S54-S58. doi: 10.15171/jlms.2019.S10. Epub 2019 Dec 1.
The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho: YAG). According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 µm fiber vaporize the stone. A total of 124 male patients with the mean age of 50.33±9.64 years and the average stone burden of 3.35±1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P≤0.05) and the mean hospital stay in favor of the TULL group (P≤0.05). The stone-free rate (SFR) was 100% in both methods after a onemonth follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods. RPCCL is a safe and effective method in bladder stone treatment and is applicable in medical centres without Ho: YAG equipment.
逆行入路是一种改良方法，它使经皮膀胱碎石术（PCCL）成为一种更具优势的方法，尤其是在设备有限的手术室中。经尿道激光膀胱结石碎石术已在泌尿外科医生中广泛应用。在本研究中，我们比较了逆行辅助入路PCCL与钬激光（Ho:YAG）经尿道膀胱碎石术的可行性和安全性。根据干预类型，将患者分为两个匹配组。在逆行辅助经皮膀胱碎石术（RPCCL）组中，通过尿道将一根导尿管插入膀胱；触诊耻骨上区域，在顶端做一个约1.5厘米的切口，然后在其上放置一个安普瑞兹鞘，进入膀胱；然后按常规进行膀胱碎石术。在经尿道钬激光碎石术（TULL）中，通过200微米的光纤汽化结石。本研究共纳入124例男性患者，平均年龄50.33±9.64岁，平均结石负荷3.35±1.07厘米。膀胱结石最常见的原因是脊髓损伤。在平均手术时间方面，RPCCL组具有统计学显著差异（P≤0.05），在平均住院时间方面，TULL组具有统计学显著差异（P≤0.05）。随访1个月后，两种方法的结石清除率（SFR）均为100%。所有干预均未改为开放手术。两种方法均未出现任何严重并发症。RPCCL是一种安全有效的膀胱结石治疗方法，适用于没有Ho:YAG设备的医疗中心。
