Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany,
Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany.
Urol Int. 2021;105(7-8):637-641. doi: 10.1159/000513457. Epub 2021 Mar 10.
Ureteropelvic junction obstruction (UPJO) and the simultaneous presence of kidney calyx stones represent a challenge for renal surgery. We present a novel technique for the simultaneous treatment of UPJO by robotic pyeloplasty in combination with the percutaneous endoscopic treatment of kidney calyx stones by flexible nephroscopy.
Between January 2018 and February 2020, 4 patients were diagnosed with UPJO and simultaneous pelvic or calyceal stones. UPJO was treated by conventional robotic pyeloplasty. After opening the renal pelvis, a flexible 16-French cystoscope was introduced via the 12-mm assistant trocar into the renal pelvis. The kidney calyx stones (n = 1-15) were removed endoscopically through a flexible nephroscope using a Dormia helical basket. Before suturing the anastomosis of the renal pelvis, a ureter stent was inserted.
After the procedure, all patients were stone free. Using the Clavien-Dindo classification, no complications were noted. The mean size of the calculi was 6.69 mm (range: 1-25). Up to 15 calyx stones (mean 3.46) were removed per patient. A complete stone clearance confirmed by postoperative X-ray imaging was achieved in all patients. The mean operative time was 149 min (range: 130-178). Mean hospital stay was 7 days (7-8). The urethral stent was removed after 4-6 weeks.
Robotic management of UPJO and simultaneous flexible nephroscopy for removal of calyceal stones is an effective treatment in 1 session. Combining robotic surgery with flexible percutaneous renal surgery is a feasible, safe, and effective method of the treatment of UPJO and concomitant calyceal stones.
肾盂输尿管连接部梗阻（UPJO）和同时存在的肾结石代表了肾脏手术的挑战。我们提出了一种新的技术，通过机器人肾盂成形术同时治疗 UPJO，并结合经皮内窥镜治疗肾结石。
在 2018 年 1 月至 2020 年 2 月期间，有 4 名患者被诊断为 UPJO 和同时存在的肾盂或肾盏结石。UPJO 通过传统的机器人肾盂成形术治疗。在打开肾盂后，通过 12 毫米的辅助套管将一个灵活的 16-French 膀胱镜引入肾盂。通过使用 Dormia 螺旋篮从柔性肾镜经皮内窥镜取出肾结石（n=1-15）。在缝合肾盂吻合口之前，插入输尿管支架。
手术后，所有患者均无结石。根据 Clavien-Dindo 分类，无并发症。结石的平均大小为 6.69 毫米（范围：1-25）。每位患者平均取出 15 个肾结石（平均 3.46 个）。所有患者均通过术后 X 射线成像证实完全清除结石。平均手术时间为 149 分钟（范围：130-178）。平均住院时间为 7 天（7-8）。尿道支架在 4-6 周后取出。
机器人治疗 UPJO 和同时进行的柔性肾镜取石术是一种有效的治疗方法，可在一次手术中完成。将机器人手术与柔性经皮肾手术相结合是治疗 UPJO 和合并肾结石的一种可行、安全、有效的方法。
