Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.
World J Urol. 2024 May 16;42(1):330. doi: 10.1007/s00345-024-04971-w.
To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy.
Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test.
The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups.
Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate.
比较针道辅助内镜手术（NAES）和逆行肾内手术（RIRS）治疗复杂肾盂肾盏解剖下盏 1-2cm 结石（LPS）的安全性和有效性。
2020 年 6 月至 2022 年 7 月，32 例肾盂肾盏解剖不利于软性输尿管镜治疗的 1-2cm LPS 患者接受了 NAES 治疗。采用配对分析（1:1 比例）比较这些患者与接受 RIRS 治疗的患者的结果。记录了年龄、性别、体重指数、结石大小、硬度和肾盂肾盏解剖特征，包括肾盂漏斗角、肾盂漏斗长度和宽度等匹配参数。采用学生 t 检验、Mann-Whitney U 检验和 Fisher 精确检验进行数据分析。
两组患者的基线特征和下盏解剖相似。两组的结石负荷相似。NAES 的初始结石清除率（SFR）明显优于 RIRS（87.5%比 62.5%，p=0.04）。NAES 和 RIRS 组的辅助率分别为 12.5%和 31.3%（p=0.13）。最后，NAES 组的 1 个月随访期 SFR 仍高于 RIRS 组（93.8%比 81.3%），但差异无统计学意义（p=0.26）。在手术时间、总并发症发生率和术后住院时间方面，两组间无差异。
与 RIRS 治疗软性输尿管镜下解剖不利于治疗的 1-2cm LPS 相比，NAES 安全有效，SFR 更高，并发症发生率相似。
