Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China.
World J Urol. 2023 Nov;41(11):3097-3103. doi: 10.1007/s00345-023-04595-6. Epub 2023 Sep 12.
This study aimed to compare the outcomes of vacuum-assisted dedusting lithotripsy (VADL) using flexible vacuum-assisted ureteral access sheath (FV-UAS) versus traditional flexible ureteroscopic lithotripsy (fURL) in patients with kidney or proximal ureteral calculi less than 3 cm in size.
A total of 371 patients who successfully underwent fURL treatment were enrolled. These patients were divided into traditional fURL group and VADL group. Outcomes of both groups were compared using 1:1 propensity score-matched analysis. Stratified analyses based on stone size and location were also conducted.
Finally, 103 well-matched patients in each group were identified. No septic shock or death occurred. The immediate stone-free rate (SFR) and follow-up SFR of VADL group were significantly higher (78.6% vs. 50.5%, p < 0.001; 94.2%% vs. 75.7%, p < 0.001). No difference was observed in postoperative fever rate (2.9% vs. 3.9%, p = 1.000) and duration of lithotripsy (37.7 ± 20.1 min vs. 40.3 ± 18.9 min, p = 0.235). For patients with stones ≤ 2 cm in size, the immediate SFR and follow-up SFR in VADL group were higher (86.7% vs. 60.6%, p < 0.001; 96.0% vs. 83.1%, p = 0.010). The same trend was observed in the 2-3 cm subgroup (57.1% vs. 28.1%, p = 0.023; 89.3% vs. 59.4%, p = 0.009). Although the in situ fragmentation strategy was employed more frequently in VADL group for lower pole stones, the SFR was still higher. Subgroup analyses did not reveal any significant differences in either infectious complications or duration of lithotripsy.
VADL technique can significantly improve the postoperative SFR for the patients with kidney or proximal ureteral stones less than 3 cm in size treated by flexible ureteroscope.
本研究旨在比较使用灵活的输尿管镜取石术（fURL）联合柔性输尿管镜辅助抽吸鞘（FV-UAS）与传统的 fURL 治疗小于 3cm 的肾结石或上段输尿管结石的效果。
共纳入 371 例成功接受 fURL 治疗的患者。将这些患者分为传统 fURL 组和 VADL 组。通过 1:1 倾向评分匹配分析比较两组的结果。还根据结石大小和位置进行了分层分析。
最终，每组各有 103 例匹配良好的患者。没有发生感染性休克或死亡。VADL 组的即刻结石清除率（SFR）和随访 SFR 明显更高（78.6%比 50.5%，p<0.001；94.2%比 75.7%，p<0.001）。术后发热率（2.9%比 3.9%，p=1.000）和碎石时间（37.7±20.1min 比 40.3±18.9min，p=0.235）无差异。对于结石大小≤2cm 的患者，VADL 组的即刻 SFR 和随访 SFR 更高（86.7%比 60.6%，p<0.001；96.0%比 83.1%，p=0.010）。在 2-3cm 亚组中也观察到了相同的趋势（57.1%比 28.1%，p=0.023；89.3%比 59.4%，p=0.009）。尽管 VADL 组为下极结石采用了原位碎石策略，但 SFR 仍更高。亚组分析未发现任何与感染并发症或碎石时间相关的显著差异。
VADL 技术可显著提高接受 fURL 治疗的肾结石或上段输尿管结石小于 3cm 患者的术后 SFR。
