The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
Nanjing Second Hospital, Nanjing, China.
Urolithiasis. 2024 Feb 10;52(1):31. doi: 10.1007/s00240-024-01539-6.
To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 2-3 cm upper urinary tract stones. A total of 160 patients with 2-3 cm upper urinary tract stones were prospectively randomized into 2 groups-80 in the FV-UAS group and 80 cases as control in the MPCNL group. The stone-free rates (SFRs) at different times (postoperative 1st day and 4th week) were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay, and operation-related complications. There was no obvious difference between the two groups in patient's demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in FV-UAS group than that in MPCNL group (5.3 vs. 10.8 g/L, P < 0.001). Postoperative hospital stay in FV-UAS group was more shorten than that in MPCNL group (2.7 vs. 4.9 days, P < 0.001). There was no statistical significance between the two groups in SFRs during postoperative 1st day and 4th week (both P > 0.05). However, in terms of the rates of bleeding and pain, MPCNL group were both significantly higher than FV-UAS group (6.2 vs. 0.0%, P = 0.023; 16.2 vs. 2.5%, P = 0.003; respectively). Our study showed that RIRS with FV-UAS, a new partnership to treat 2-3 cm upper urinary tract stones, was satisfying as it achieved a high SFR rate and a low rate of complications. This method was safe and reproducible in clinical practice.
观察逆行肾内手术（RIRS）联合柔性真空辅助输尿管进入鞘（FV-UAS）和微创经皮肾镜取石术（MPCNL）治疗 2-3cm 上尿路结石患者的疗效和安全性。将 160 例 2-3cm 上尿路结石患者前瞻性随机分为 2 组，FV-UAS 组 80 例，MPCNL 组 80 例。以术后第 1 天和第 4 周的结石清除率（SFR）作为主要研究终点。次要终点为手术时间、血红蛋白下降、术后住院时间和手术相关并发症。两组患者的人口统计学和术前临床特征无明显差异（均 P＞0.05）。术后数据显示，FV-UAS 组血红蛋白水平下降均值低于 MPCNL 组（5.3 比 10.8g/L，P＜0.001）。FV-UAS 组术后住院时间较 MPCNL 组缩短（2.7 比 4.9 天，P＜0.001）。术后第 1 天和第 4 周两组 SFR 无统计学差异（均 P＞0.05）。然而，在出血和疼痛发生率方面，MPCNL 组均显著高于 FV-UAS 组（6.2 比 0.0%，P=0.023；16.2 比 2.5%，P=0.003）。本研究表明，RIRS 联合 FV-UAS 治疗 2-3cm 上尿路结石疗效满意，结石清除率高，并发症发生率低。该方法在临床实践中安全且可重复。
