Kawase Kengo, Hamamoto Shuzo, Taguchi Kazumi, Inoue Takaaki, Okada Shinsuke, Sugino Teruaki, Isogai Masahiko, Torii Koei, Yanase Takahiro, Okada Tomoki, Hattori Tatsuya, Chaya Ryosuke, Okada Atsushi, Yasui Takahiro
Department of Nephro-Urology Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
SMART Study Group Japan.
BJUI Compass. 2022 Dec 16;4(2):173-180. doi: 10.1002/bco2.209. eCollection 2023 Mar.
The objective of this work is to investigate the impact of the pelvicalyceal anatomical system (PCS) on calyceal stone formation and surgical outcomes of endoscopic combined intrarenal surgery (ECIRS) for renal and/or proximal ureteral stones with a diameter >15 mm.
PCS was classified as Type I (single pelvis) or Type II (divided pelvis) according to the simple anatomical Takazawa classification. Using prospectively collected data from January 2016 to April 2020, 219 patients were retrospectively reviewed. After excluding patients who underwent a staged procedure, had hydronephrosis greater than grade 2, prior nephrostomy tubes, and failed to access the renal collecting system, 115 patients (Type I: 81, Type II: 34) were included, and the distribution of calyceal stones and surgical outcomes in ECIRS were compared between Types I and II PCS.
The median number of renal stone calyces in the Type II group was significantly more than that in the Type I group ( = 0.016). In particular, the Type II group possessed more upper stone calyces. Multivariate logistic regression analysis revealed that Type II PCS was associated with an increased odds ratio (OR) for the presence of upper stone calyces (OR: 2.93, = 0.018). The stone-free (SF) status at 1 month after surgery, confirmed by abdominal plain radiography, was significantly higher in the Type I group compared with that in Type II (67.9% vs. 39.4%, respectively; = 0.006). The requirement for additional surgical interventions was significantly higher in the Type II group compared with that in Type I (35.4% vs. 7.4%, respectively; < 0.001). Multivariate analysis revealed that the number of stone calyces (OR: 4.26; = 0.001) and Type II PCS (OR: 3.43; = 0.009) were independent predictors of residual stones after ECIRS.
We first revealed that the anatomic properties of PCS play a role in both upper calyceal stone formation and in the success of the ECIRS procedure. Because the SF rate in Type II PCS was significantly lower than that in Type I PCS, additional percutaneous nephrolithotomy tracts might be required, even for ECIRS.
本研究旨在探讨肾盂肾盏解剖系统（PCS）对直径>15mm的肾和/或近端输尿管结石的肾盏结石形成及内镜联合肾内手术（ECIRS）手术效果的影响。
根据简单的解剖学Takazawa分类法，将PCS分为I型（单肾盂）或II型（分叶肾盂）。回顾性分析2016年1月至2020年4月前瞻性收集的数据，共纳入219例患者。排除接受分期手术、肾盂积水大于2级、既往有肾造瘘管以及未能进入肾集合系统的患者后，纳入115例患者（I型：81例，II型：34例），比较I型和II型PCS患者肾盏结石的分布及ECIRS手术效果。
II型组肾盏结石的中位数显著多于I型组（P = 0.016）。特别是，II型组上盏结石更多。多因素logistic回归分析显示，II型PCS与上盏结石存在的比值比（OR）增加相关（OR：2.93，P = 0.018）。术后1个月经腹部平片证实的结石清除（SF）状态，I型组显著高于II型组（分别为67.9%和39.4%；P = 0.006）。II型组额外手术干预的需求显著高于I型组（分别为35.4%和7.4%；P < 0.001）。多因素分析显示，结石肾盏数量（OR：4.26；P = 0.001）和II型PCS（OR：3.43；P = 0.009）是ECIRS术后残留结石的独立预测因素。
我们首次揭示，PCS的解剖特性在上盏结石形成及ECIRS手术成功中均起作用。由于II型PCS的结石清除率显著低于I型PCS，即使是ECIRS手术，可能也需要额外的经皮肾镜取石通道。
