Birowo Ponco, Raharja Putu Angga Risky, Atmoko Widi, Rasyid Nur
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, 10430, Indonesia.
Res Rep Urol. 2021 Mar 4;13:121-125. doi: 10.2147/RRU.S299707. eCollection 2021.
X-ray-free endoscopic combined intra renal surgery (ECIRS) is a feasible alternative to avoid radiation exposure to both surgical teams and patients, but has not been reported prior. The aim of this report is to present our first-hand experience of performing X-ray-free ECIRS for complex ureteral stone. A 57-year-old female presented with right flank pain, fever, dysuria, and leukocytosis. The computed tomography scan showed right impacted proximal ureteral stone sized 33 ´17 mm and grade IV hydronephrosis. Percutaneous nephrostomy was performed immediately. With improvement of clinical symptoms two days after nephrostomy, X-ray-free ECIRS was performed. The patient was placed in a Galdakao-modified supine position. During ureteroscopy (URS), there was noted right ureteral stenosis in the distal part of the stone, which could be passed. However, the stone was impacted and the semi-rigid URS was not able to push it. Therefore, antegrade approach with percutaneous nephrolithotomy was performed. Previous nephrostomy tract was used as percutaneous access. Tract dilatation was performed under direct visualization from the URS. The 28 Fr rigid nephroscope was used during the ECIRS procedure. The stone was fragmented using shock-pulse lithotripters. There was no residual stone or infundibular laceration after the procedure. A 6 Fr double J stent was inserted retrogradely due to ureteral stenosis. There was no complication during and after the procedure. The patient was discharged on post-operative day three. X-ray free ECIRS for complex proximal ureteral stone was possible and showed good results.
无X线内镜联合肾内手术（ECIRS）是一种可行的替代方法，可避免手术团队和患者受到辐射暴露，但此前尚未见报道。本报告的目的是介绍我们在复杂输尿管结石患者中进行无X线ECIRS的第一手经验。一名57岁女性，出现右侧腰痛、发热、排尿困难和白细胞增多。计算机断层扫描显示右侧近端输尿管结石嵌顿，大小为33×17mm，伴有IV级肾积水。立即进行了经皮肾造瘘术。肾造瘘术后两天临床症状改善后，进行了无X线ECIRS。患者置于改良仰卧位。输尿管镜检查（URS）时，发现结石远端右侧输尿管狭窄，但可通过。然而，结石嵌顿，半硬性URS无法推动。因此，采用经皮肾镜取石术的顺行入路。以前的肾造瘘通道用作经皮入路。在URS的直视下进行通道扩张。ECIRS手术期间使用28F硬性肾镜。使用冲击脉冲碎石器将结石击碎。术后无残留结石或肾盂撕裂。由于输尿管狭窄，逆行插入一根6F双J支架。手术期间及术后均无并发症。患者术后第三天出院。无X线ECIRS治疗复杂近端输尿管结石是可行的，且效果良好。
