Kozyrakis Diomidis, Soukias Georgios, Karagiannis Dimitrios, Zarkadas Anastasios, Perikleous Stefanos, Chatzistamou Styliani-Elissavet, Katsaros Ilias, Skriapas Konstantinos, Lardas Michael, Mertziotis Nikolaos, Kratiras Zisis
Department of Urology, 'Achillopoulio' General Hospital, Volos 32222, Greece.
Department of Urology, 'Metropolitan' General Hospital, Athens 15562, Greece.
Exp Ther Med. 2022 Apr;23(4):294. doi: 10.3892/etm.2022.11221. Epub 2022 Feb 17.
Treatment of large and multiple stones located in the ureter and/or the kidney may be challenging. The aim of the current study was to evaluate the results and complications of retrograde endoscopic lithotripsy for stones located in the urinary tract and to determine prognostic factors for treatment outcome. From April 2017 to March 2020, eligible patients for the active treatment of ureterolithiasis with or without concomitant nephrolithiasis <20 mm were enrolled in the study. The prognostic factors for the stone free rate (SFR) after the 1st and subsequent sessions and overall complications were assessed. Patients were divided into single or multiple lithiasis groups (groups A and B respectively). A comparison between these two groups was then conducted. Overall, 237 stones were detected in 155 patients, representing a mean burden of 1.53 stone per patient. The mean total stone size was 14.7 mm, the initial SFR was 80% and the final SFR (after a mean of 1.23 session per patient) was 94.2%. The rate of complications was 26.4%. Multivariative analysis revealed that preoperative stenting and total stone size were independent prognostic factors of initial SFR, while no independent factors were determined for final SFR. Age, total size and stones in the lower calyx were independent factors for complications. In group A and B, 114 and 41 cases with solitary and multiple stones were included, respectively. Excluding operation time (P=0.002), no significant differences were recorded in terms of initial (P=0.255) and final SFR (P=0.056), hospital stay (P=0.308), mean number of treatments (P=0.757) and the rate of complications (P=0.218) between the two groups. In conclusion, retrograde endoscopic management of multiple lithiasis has a favorable outcome irrespective of stone location. Older patients with higher burdens and stones in the lower calyx should be treated with caution.
治疗位于输尿管和/或肾脏的大结石及多发结石可能具有挑战性。本研究的目的是评估逆行内镜碎石术治疗尿路结石的结果和并发症，并确定治疗结果的预后因素。2017年4月至2020年3月，纳入了有或无合并<20 mm肾结石的输尿管结石积极治疗的合格患者。评估了首次及后续治疗后结石清除率（SFR）和总体并发症的预后因素。患者分为单发或多发结石组（分别为A组和B组）。然后对这两组进行比较。总体而言，155例患者中检测到237颗结石，平均每位患者有1.53颗结石。结石平均总大小为14.7 mm，初始SFR为80%，最终SFR（每位患者平均治疗1.23次后）为94.2%。并发症发生率为26.4%。多变量分析显示，术前支架置入和结石总大小是初始SFR的独立预后因素，而最终SFR未确定独立因素。年龄、总大小和下盏结石是并发症的独立因素。A组和B组分别纳入了114例单发结石和41例多发结石病例。除手术时间（P=0.002）外，两组在初始（P=0.255）和最终SFR（P=0.056）、住院时间（P=0.308）、平均治疗次数（P=0.757）和并发症发生率（P=0.218）方面无显著差异。总之，无论结石位置如何，逆行内镜治疗多发结石均有良好疗效。年龄较大、结石负荷较高且下盏有结石的患者应谨慎治疗。
