Feng Dechao, Wei Wuran
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2021 Sep 29;8:743813. doi: 10.3389/fsurg.2021.743813. eCollection 2021.
Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.
对于鹿角形肾结石患者，保守治疗与肾功能恶化密切相关。众所周知，经皮肾镜取石术（PCNL）因其结石清除率高且与其他治疗方法（如冲击波碎石术和软性输尿管镜检查（FURS））相比具有成本效益，被推荐作为直径大于2 cm肾结石的一线治疗方法。此外，我们的研究结果表明，微通道经皮肾镜取石术可作为经皮肾镜取石术的替代方法，其结石清除率更高，出血风险更低。尽管经皮肾镜取石术具有较高的成本效益，但在一些特殊情况下，如孤立肾，鹿角形结石的治疗仍存在争议。在此，我们报告一例右侧孤立肾复杂性感染性结石患者，主诉右腰部持续性疼痛。该病例的罕见之处在于临床上很难遇到这种对钬激光碎石术耐药的棉絮状鹿角形结石，其特殊性在于孤立肾患者未能接受经皮肾镜取石术。我们发现，间歇性高频振荡联合软性输尿管镜取石钳可能有助于治疗孤立肾患者的复杂性感染性结石。我们的手术经验可能对临床实践中接受软性输尿管镜检查的此类患者有益。
