Urology Unit - Cannizzaro Hospital, Catania.
Urology Unit - S. Croce and Carle Hospital, Cuneo.
Arch Ital Urol Androl. 2021 Oct 1;93(3):313-317. doi: 10.4081/aiua.2021.3.313.
The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS).
A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments.
The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA).
The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.
本研究旨在报告接受逆行性肾内手术（RIRS）治疗的患者的无石率（SFR）和临床并发症。
分析了 2014 年 1 月至 2020 年 2 月期间使用柔性输尿管镜和钬激光碎石术治疗的 571 例上尿路结石患者的资料。术后 3 个月通过非对比计算机断层扫描评估整体 SFR。成功定义为无结石状态或 ≤ 0.4cm 的结石碎片。
在结石大小<1cm 的第 1 组中，整体 SFR 为 92.3%；在结石大小>1cm≤2cm 的第 2 组中，整体 SFR 为 88.3%；在结石大小为 2-3cm 的第 3 组中，整体 SFR 为 56.7%；在多发结石的第 4 组中，整体 SFR 为 69.6%。根据 Clavien-Dindo（CD）分类系统记录了 32 例（5.6%）术后并发症。记录的主要并发症包括：一例术后两天出现与肺栓塞相关的包膜下血肿（SRH）（CD 分级 IIIa），保守治疗；一例术后 2 小时发生失血性休克伴多处肾出血，需要紧急肾切除术（CD 分级 IVA）。
RIRS 是一种有效且安全的手术，其 SFR 与结石大小显著相关；同时，RIRS 可能伴有严重的临床并发症，需要快速诊断和及时治疗。
