Huang Xin, Song Leming, Deng Xiaolin, Chen Hua, Xiao Jiansheng, Kuang Jin, Wang Zhiwen, Deng Xiaoling, Zhai Qiliang
Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China.
Department of Central Laboratory, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China.
Minerva Urol Nephrol. 2024 Aug 2. doi: 10.23736/S2724-6051.24.05814-2.
Retrograde intrarenal surgery (RIRS) is being increasingly used to treat 2-4 cm renal stones, which can be attributed to advances in flexible ureteroscopes and ureteral access sheaths (UASs). Despite the improvement and application of flexible vacuum-assisted (FV) and intelligent pressure-controlled (IPC) UASs, no studies have compared their therapeutic efficacy and safety. Therefore, this study aimed to compare the therapeutic efficacy and safety of IPC-UAS and FV-UAS in RIRS 2-4 cm renal stones.
We included 96 and 103 patients who underwent IPC-UAS and FV-UAS RIRS, respectively, for 2-4 cm renal stones. Stone-free rate (SFR), operative time, and complications were compared between the two groups.
The immediate SFR was 69.8% and 82.5% in the IPC-UAS and FV-UAS groups, respectively (P<0.05). There were no significant between-group differences in the 1-month SFR (84.4% vs. 84.5%, P>0.05). The IPC-UAS group had a shorter hospital stay (5.2±2.4 vs. 6.2±3.2 days, P=0.018) and lower cost (CNY13014.7±3240.7 vs. CNY14022.5±2301.6, P=0.012) than the FV-UAS group. There were no significant between-group differences in operative time or complications.
Regarding RIRS for 2-4 cm renal stones, the IPC-UAS group can achieve a 1-month SFR similar to that of the FV-UAS group, with shorter hospitalization and lower cost. Additionally, the IPC-UAS is a promising device for efficient and safe RIRS, considering its intelligent pressure regulation. Our findings could inform optimal UAS selection for managing large renal calculi and demonstrate the utility of the novel IPC-UAS in improving outcomes of RIRS for 2-4 cm renal stones.
逆行性肾内手术（RIRS）越来越多地用于治疗2 - 4厘米的肾结石，这可归因于可弯曲输尿管镜和输尿管通路鞘（UASs）的进展。尽管可弯曲真空辅助（FV）和智能压力控制（IPC）UASs有所改进和应用，但尚无研究比较它们的治疗效果和安全性。因此，本研究旨在比较IPC - UAS和FV - UAS在RIRS治疗2 - 4厘米肾结石中的治疗效果和安全性。
我们分别纳入了96例和103例接受IPC - UAS和FV - UAS RIRS治疗2 - 4厘米肾结石的患者。比较两组的结石清除率（SFR）、手术时间和并发症。
IPC - UAS组和FV - UAS组的即刻SFR分别为69.8%和82.5%（P<0.05）。两组1个月时的SFR无显著差异（84.4%对84.5%，P>0.05）。IPC - UAS组的住院时间较短（5.2±2.4天对6.2±3.2天，P = 0.018），费用较低（13014.7±3240.7元对14022.5±2301.6元，P = 0.012），优于FV - UAS组。两组在手术时间或并发症方面无显著差异。
对于2 - 4厘米肾结石的RIRS，IPC - UAS组可实现与FV - UAS组相似的1个月SFR，且住院时间更短、费用更低。此外，考虑到其智能压力调节，IPC - UAS是一种有前景的用于高效安全RIRS的设备。我们的研究结果可为管理大型肾结石的最佳UAS选择提供参考，并证明新型IPC - UAS在改善2 - 4厘米肾结石RIRS结局方面的效用。
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