Department of Urology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
"Sfantul Ioan" Emergency Clinical Hospital, 042122 Bucharest, Romania.
Medicina (Kaunas). 2023 Jan 8;59(1):124. doi: 10.3390/medicina59010124.
Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.
肾结石较为常见，成人终生患病率为 10%。软式输尿管镜能够让泌尿科医生通过自然腔道治疗下盏结石，甚至复杂肾结石，达到可接受的无石率。因此，我们分析了 FURS 与 PCNL 治疗直径 20-40mm 肾结石的有效性和安全性。
我们回顾性分析了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间 250 例患有大的孤立肾结石（结石负荷 2-4cm）的连续患者。患者被分为两组：组 1（125 例患者）采用逆行软式输尿管镜治疗，组 2（125 例患者）采用经皮肾镜碎石术。根据 CT 和/或 KUB（肾脏-输尿管-膀胱）影像学存档观察结石特征和解剖数据。
组 1的平均结石负荷为 26.38±4.453mm，组 2的平均结石负荷为 29.44±4.817mm。PNL 组（90.4%）的第一次输尿管镜碎石术后无石率高于 F-URS 组（68%）。第一次输尿管镜碎石术后，第一组的 SFR 为 88.8%，经过三次手术后，SFR 上升至 95.2%。组 1的总体并发症发生率高于组 2（18.4% vs. 16.8%），但无统计学意义（p>0.5）。此外，PNL 组出现更多 3 级和 4 级并发症（8.8% vs. 4.8%，p<0.05）。
软式输尿管镜治疗 2cm 以上肾结石有效。然而，必须告知患者可能需要多次手术才能清除所有结石。
