Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Urology, Wakayama Medical University, Wakayama, Japan.
Int J Urol. 2021 Sep;28(9):913-919. doi: 10.1111/iju.14603. Epub 2021 May 24.
To assess the impact and availability of ureteroscopy-assisted puncture for percutaneous renal access during ultrasonography-guided miniaturized (mini)-endoscopic combined intrarenal surgery for large volume renal and/or proximal ureteral stones.
We conducted a multi-institutional retrospective cohort study for urolithiasis treatment. Data from a total of 313 patients who underwent mini-endoscopic combined intrarenal surgery to treat renal and/or ureteral stones between January 2016 and April 2020 were collected. We compared the outcomes between ultrasonography-guided mini-endoscopic combined intrarenal surgery with and without ureteroscopy-assisted puncture (ureteroscopy-assisted puncture(+) group [n = 126] and ureteroscopy-assisted puncture(-) group [n = 187] group, respectively). The primary outcome was requirement for additional surgical intervention. Secondary outcomes were stone-free rate, complications and total procedure, fluoroscopy, hospital stay, and postoperative ureteral stent placement durations.
The ureteroscopy-assisted puncture(+) group had a lower additional surgical intervention rate and a higher stone-free rate immediately after and 3 months after surgery than the ureteroscopy-assisted puncture(-) group (5.6% vs 19.7%, P < 0.001; 82.5% vs 65.8%, P = 0.001; 59.5% vs 44.6%, P = 0.011). The median total procedure, fluoroscopy, and postoperative ureteral stent placement durations were 18 min, 3 min, and 5 days shorter, respectively, in the ureteroscopy-assisted puncture(+) group. Multivariate analyses showed that ureteroscopy-assisted puncture was associated with a decreased risk of additional surgical intervention (odds ratio 0.31, P = 0.011) and postoperative infection (odds ratio 0.34, P = 0.003) and decreased total procedure (estimate = -11 min; P = 0.011), fluoroscopy (estimate = -3 min; P = 0.034), and postoperative ureteral stent placement (estimate = -8 days; P = 0.011) durations. Female patients and those with smaller stone volumes or without hydronephrosis were identified as ideal ureteroscopy-assisted puncture candidates.
Ureteroscopy-assisted puncture during mini-endoscopic combined intrarenal surgery could provide favorable surgical outcomes, especially in female patients without collecting system obstruction.
评估在超声引导下经皮肾微通道取石术（mini-PCNL）中，输尿管镜辅助穿刺对经皮肾通道建立的影响和可用性，用于治疗体积较大的肾结石和/或上段输尿管结石。
我们进行了一项多机构回顾性队列研究，以评估结石治疗方法。共纳入 2016 年 1 月至 2020 年 4 月期间接受 mini-PCNL 治疗肾结石和/或输尿管结石的 313 例患者。比较了超声引导下 mini-PCNL 联合输尿管镜辅助穿刺（输尿管镜辅助穿刺（+）组 [n=126] 和输尿管镜辅助穿刺（-）组 [n=187]）的结局。主要结局为是否需要额外的手术干预。次要结局包括结石清除率、并发症发生率、总手术时间、透视时间、住院时间和术后输尿管支架放置时间。
输尿管镜辅助穿刺（+）组的额外手术干预率较低，术后即刻和 3 个月的结石清除率较高（5.6%比 19.7%，P<0.001；82.5%比 65.8%，P=0.001；59.5%比 44.6%，P=0.011）。输尿管镜辅助穿刺（+）组的总手术时间、透视时间和术后输尿管支架放置时间分别缩短 18 分钟、3 分钟和 5 天。多变量分析显示，输尿管镜辅助穿刺与降低额外手术干预风险（比值比 0.31，P=0.011）和术后感染风险（比值比 0.34，P=0.003）以及缩短总手术时间（估计值为-11 分钟；P=0.011）、透视时间（估计值为-3 分钟；P=0.034）和术后输尿管支架放置时间（估计值为-8 天；P=0.011）有关。女性患者和结石体积较小或无肾盂积水的患者被认为是输尿管镜辅助穿刺的理想人选。
在 mini-PCNL 中进行输尿管镜辅助穿刺可以提供良好的手术效果，特别是对于无集合系统梗阻的女性患者。
