University Malaya, Department of Surgery Urology Unit, Kuala Lumpur, Malaysia.
University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom.
Urology. 2024 Apr;186:117-122. doi: 10.1016/j.urology.2024.02.031. Epub 2024 Feb 28.
To compare same-sitting bilateral vs unilateral retrograde intrarenal surgery (RIRS) in elderly patients, focusing on postoperative complications and stone-free rates (SFR).
Data from 2 multicenter databases, FLEXible ureteroscopy Outcomes Registry (FLEXOR) (unilateral RIRS) and same sitting bilateral-retrograde intrarenal surgery (SSB-RIRS) (bilateral RIRS), were analyzed, considering only patients aged 70+ with preoperative computed tomography. Patients were categorized into Group 1 (bilateral RIRS) and Group 2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed.
Group 1 included 146 patients, while group 2 had 495. Group 1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group 2 often underwent RIRS for incidental stones. Group 1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group 1. Group 2 had significantly higher overall stone-free rates, although there were no significant differences in ancillary procedures for residual fragments. Group 1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op hematuria not requiring transfusion.
In conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counseling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.
比较老年患者同次坐位双侧与单侧逆行性肾内手术（RIRS），重点关注术后并发症和结石清除率（SFR）。
分析了 FLEXible ureteroscopy Outcomes Registry（FLEXOR）（单侧 RIRS）和同次坐位双侧逆行性肾内手术（SSB-RIRS）（双侧 RIRS）两个多中心数据库的数据，仅考虑了术前 CT 检查的 70 岁以上患者。患者分为第 1 组（双侧 RIRS）和第 2 组（单侧 RIRS）。随访包括影像学评估和根据需要进行二次治疗。
第 1 组包括 146 例患者，第 2 组包括 495 例患者。第 1 组患者年龄稍大，且结石复发率较高。第 2 组常因偶然发现的结石行 RIRS。第 1 组的结石较大且多位于肾盂。第 1 组的激光碎石术和总手术时间明显更长。第 2 组的总体结石清除率明显更高，尽管在处理残余碎片的辅助手术方面没有显著差异。第 1 组发生更多需要支架置入的肾盂肾盏损伤、术后发热和术后血尿无需输血。
总之，双侧 RIRS 可谨慎用于老年患者。对于初次和重复 RIRS 手术，术前咨询至关重要，需要进一步研究以优化器械和激光策略，从而改善老年 RIRS 患者的预后。
