Xiong Lin, Kwan Kristine J S, Xu Xiang, Wei Geng-Geng, Yuan Yuan, Lu Zhen-Quan
Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Transl Androl Urol. 2024 Jan 31;13(1):185-191. doi: 10.21037/tau-23-424. Epub 2023 Dec 22.
Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large renal stones. However, multi-tract or staged procedures may be necessitated in bilateral or anatomically-complex stones to achieve stone clearance. Endoscopic combined intrarenal surgery (ECIRS) integrates the advantages of PCNL and retrograde intrarenal surgery. In this article, we detail a hybrid surgical technique adopted for the management of complex simultaneous bilateral upper urinary tract stones. In addition, we discuss the advantages and disadvantages of combining a variety of new techniques that may improve post-operative outcomes and patient satisfaction.
We report the case of a 36-year-old male with a large left renal pelvis stone, right proximal ureteric stone, and bilateral renal stones. Biochemical results showed raised inflammatory markers but he denied pre-stenting and staged surgery. After receiving 3-day antibiotic prophylaxis, he underwent an elective hybrid procedure. Under split-leg prone position, we performed a hybrid procedure that included left ECIRS with tubeless single-tract mini PCNL and left flexible ureteroscopy, and right flexible ureteroscopic lithotripsy. Hemostasis was achieved by electrocauterization with a novel device. The patient made an uneventful recovery. Follow-up computed tomography (CT) at 1-month revealed complete stone clearance.
Unilateral ECIRS with tubeless single-tract mini PCNL with electrocoagulation hemostasis and adjacent retrograde intrarenal surgery in split-leg prone position is a safe, feasible, and efficient technique to manage large renal stones.
经皮肾镜取石术（PCNL）是治疗大型肾结石的一线疗法。然而，对于双侧或解剖结构复杂的结石，可能需要采用多通道或分期手术来实现结石清除。内镜联合肾内手术（ECIRS）融合了PCNL和逆行肾内手术的优点。在本文中，我们详细介绍了一种用于处理复杂同时性双侧上尿路结石的混合手术技术。此外，我们还讨论了结合多种新技术的优缺点，这些新技术可能会改善术后效果和患者满意度。
我们报告了一例36岁男性患者，患有左侧肾盂大结石、右侧输尿管上段结石及双侧肾结石。生化检查结果显示炎症标志物升高，但患者拒绝术前支架置入和分期手术。在接受3天的抗生素预防后，他接受了择期混合手术。在分腿俯卧位下，我们进行了一项混合手术，包括左侧ECIRS联合无管单通道微型PCNL及左侧软性输尿管镜检查，以及右侧软性输尿管镜碎石术。使用一种新型设备通过电灼实现止血。患者恢复顺利。术后1个月的随访计算机断层扫描（CT）显示结石完全清除。
在分腿俯卧位下进行单侧ECIRS联合无管单通道微型PCNL及电凝止血以及相邻的逆行肾内手术，是一种安全、可行且有效的治疗大型肾结石的技术。
