Bosio Andrea, Alessandria Eugenio, Dalmasso Ettore, Agosti Simone, Vitiello Federico, Vercelli Eugenia, Bisconti Alessandro, Gontero Paolo
Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy.
Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy.
Eur Urol Focus. 2022 Nov;8(6):1816-1822. doi: 10.1016/j.euf.2022.04.004. Epub 2022 Apr 22.
No clear recommendations are available on whether retrograde intrarenal surgery (RIRS) via flexible ureterorenoscopy or shockwave lithotripsy (SWL) should be preferred for kidney stones ≤2 cm, except for lower-pole stones.
To compare outcomes between RIRS and SWL.
DESIGN, SETTING, AND PARTICIPANTS: This was a single-center randomized controlled trial from March 2015 to May 2018. Patients with a single 6-20-mm kidney stone were enrolled (NCT02645058).
Patients were randomized to RIRS or SWL.
The primary endpoint was the single-procedure stone-free rate (SFR) at 1 mo. Two levels of success were set: fragments ≤4 mm (SFR-4) and no residual fragments (SFR-0). Secondary endpoints were the SFR at 6 mo and 1 yr and rates of complications and further treatments.
A total of 138 patients underwent treatment (70 RIRS vs 68 SWL). In comparison to SWL, RIRS SFR results were higher at 1 mo (SFR-4 70.0% vs 45.6%; p = 0.004; SFR-0 50.0% vs 26.5%; p = 0.004) and 6 mo (SFR-4 79.7% vs 63.6%; p = 0.038; SFR-0 59.4% vs 40.9%; p = 0.032). There was no difference in SFR measures between the groups at 1 yr (SFR-4 p = 0.322; SFR-0 p = 0.392). Overall complications were comparable (p = 0.207), but the complication rate for stones >10 mm was higher for the SWL group (p = 0.021). The need for further treatment was comparable (p = 0.368). In terms of patient satisfaction, 86.8% and 77.1% of patients would choose SWL and RIRS again, respectively (p = 0.24).
RIRS achieved better SFRs in comparison to SWL at 1 and 6 mo, but not at 1 yr. The RIRS complication rate was lower for stones >10 mm. SWL remains a viable alternative, especially for 6-10-mm stones, providing comparable results to RIRS in the long term.
We compared outcomes for the treatment of kidney stones ≤2 cm with two techniques: flexible ureteroscopy, in which a flexible telescope is passed through the urethra and bladder to reach the ureter between the bladder and kidney; and shockwave lithotripsy, in which shockwaves are applied to the skin over the location of the kidney stone. Ureteroscopy achieved better stone-free results at 1 and 6 months, but not at 1 year.
除了下极结石外，对于直径≤2cm的肾结石，采用软性输尿管肾镜逆行肾内手术（RIRS）还是冲击波碎石术（SWL）更优，目前尚无明确的推荐意见。
比较RIRS和SWL的治疗效果。
设计、地点和参与者：这是一项于2015年3月至2018年5月开展的单中心随机对照试验。纳入了患有单个6-20mm肾结石的患者（NCT02645058）。
患者被随机分为RIRS组或SWL组。
主要终点是1个月时的单次手术无石率（SFR）。设定了两个成功水平：结石碎片≤4mm（SFR-4）和无残留碎片（SFR-0）。次要终点是6个月和1年时的SFR以及并发症和进一步治疗的发生率。
共有138例患者接受了治疗（70例接受RIRS，68例接受SWL）。与SWL相比，RIRS在1个月时的SFR结果更高（SFR-4为70.0%对45.6%；p = 0.004；SFR-0为50.0%对26.5%；p = 0.004）以及6个月时（SFR-4为79.7%对63.6%；p = 0.038；SFR-0为59.4%对40.9%；p = 0.032）。两组在1年时的SFR测量结果无差异（SFR-4，p = 0.322；SFR-0，p = 0.392）。总体并发症发生率相当（p = 0.207），但SWL组中结石>10mm的并发症发生率更高（p = 0.021）。进一步治疗的需求相当（p = 0.368）。在患者满意度方面，分别有86.8%和77.1%的患者会再次选择SWL和RIRS（p = 0.24）。
与SWL相比，RIRS在1个月和6个月时的SFR更高，但在1年时并非如此。对于结石>10mm，RIRS的并发症发生率更低。SWL仍然是一种可行的选择，特别是对于6-10mm的结石，从长期来看与RIRS的效果相当。
我们比较了两种治疗直径≤2cm肾结石的技术的效果：软性输尿管镜检查，即通过尿道和膀胱插入软性望远镜以到达膀胱和肾脏之间的输尿管；以及冲击波碎石术，即将冲击波作用于肾结石所在位置的皮肤。输尿管镜检查在1个月和6个月时取得了更好的无石效果，但在1年时并非如此。
