Ain Shams University Hospitals, Cairo, 11361, Egypt.
Int Urol Nephrol. 2021 Feb;53(2):211-217. doi: 10.1007/s11255-020-02639-z. Epub 2020 Sep 14.
To evaluate the simultaneous antegrade and retrograde endourological approach in the Galdakao-modified supine Valdivia position (GMSVP) for the management of missed stent with complex renal stones.
Over 5 years, patients presented to our clinic or referred to our hospital with missed DJ stent and complex renal stones were included prospectively in our study. Inclusion criteria were patients with neglected DJ stents (more than 6 months) complicated with complex stone burden, in addition to stents that was Fragmented and required renal access for removal. Stent and stone removal were performed using a simultaneous antegrade and retrograde renal approach in the GMSVP. The success rate and any perioperative complications were recorded.
45 patients were available for evaluation. The average stone size was 3.9 ± 0.8 cm. Renal stones, ureteric stones, and bladder stones were present in 39, 24, and 10 patients, respectively .Two patients had fragmented DJs. Semirigid ureteroscopy with PCNL was used in 19 (42.2%) cases, ECIRS in 17 (37.7%) cases, Cystolitholapaxy and PCNL in 10 (22.2%) cases. Mean operative time was 70.8 ± 10.2 min, mean hospital stay was 2.3 ± 0.8 days. The stone-free rate was 93.3% after one procedure, two patients needed an auxiliary SWL for residual stones, postoperative complications were seen in 24.4% of patients.
Simultaneous antegrade and retrograde renal approach in the GMSVP is safe and effective in the management of missed DJ stents with a complex stone burden.
评估改良仰卧位下逆行顺行联合腔内泌尿外科方法（GMSVP）在处理遗留 DJ 支架和复杂肾结石中的应用。
在 5 年多的时间里，前瞻性纳入了因遗留 DJ 支架（超过 6 个月）合并复杂结石负荷，以及支架断裂需要肾内进入以取出的患者。纳入标准为忽视的 DJ 支架（超过 6 个月）患者，同时合并复杂结石负荷，支架断裂，需要肾内进入以取出。支架和结石的取出采用 GMSVP 下逆行顺行联合的腔内泌尿外科方法。记录成功率和任何围手术期并发症。
45 例患者可进行评估。平均结石大小为 3.9±0.8cm。39 例患者有肾结石，24 例有输尿管结石，10 例有膀胱结石。2 例患者的 DJ 支架断裂。19 例（42.2%）采用半硬性输尿管镜联合 PCNL，17 例（37.7%）采用经皮肾镜逆行取石术，10 例（22.2%）采用膀胱镜碎石取石术联合 PCNL。手术时间平均为 70.8±10.2min，平均住院时间为 2.3±0.8 天。1 次手术结石清除率为 93.3%，2 例患者因残留结石需要辅助体外冲击波碎石术，24.4%的患者出现术后并发症。
GMSVP 下逆行顺行联合腔内泌尿外科方法在处理遗留 DJ 支架和复杂结石负荷时是安全有效的。
