Men Chao, Xu Miao, Zhang Si-Cong, Wang Qing, Wu Jie, Li Yun-Peng
Department of Urology, Chifeng Cancer Hospital, Chifeng, China.
Department of Urology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
Front Med (Lausanne). 2024 Oct 30;11:1464491. doi: 10.3389/fmed.2024.1464491. eCollection 2024.
To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of 1-2 cm lower pole renal calculi (LPC) in obese patients.
This prospective, randomized study included 149 obese patients with 1-2 cm LPC. Patients were allocated into two groups: 76 patients underwent RIRS with FV-UAS, and 73 patients received ESWL. The parameters assessed included stone-free rate (SFR), retreatment rate, complications, operative time, and pain intensity measured by the visual analog scale (VAS). Stone-free status was defined as the absence of stones on computed tomography or residual fragments smaller than 4 mm at 4 weeks post-procedure.
The baseline characteristics of the two groups were comparable. The SFR was significantly higher in the RIRS group, reaching 86.8%, compared to 63.0% in the ESWL group ( = 0.034). Furthermore, the retreatment rate was significantly lower in the RIRS group, at 5.2%, versus 24.7% in the ESWL group ( < 0.001). The average operative time for RIRS was notably longer, at 65.3 ± 6.4 min, compared to 25.3 ± 7.8 min for ESWL ( < 0.001). The complication rates were 9.2% for the RIRS group and 6.8% for the ESWL group, with no statistically significant difference ( = 0.326). All complications were classified as Grade I or II according to the modified Clavien classification system. No significant differences were observed between the two groups regarding pain VAS scores and the composition of the stones.
RIRS with FV-UAS demonstrated superior efficacy, evidenced by a higher SFR and reduced retreatment rates compared to ESWL, despite a longer operative duration. Both treatment modalities showed comparable safety profiles. RIRS with FV-UAS emerges as a viable, effective, and reproducible intervention for managing 1-2 cm LPC in obese patients, providing significant clinical advantages.
评估逆行肾内手术（RIRS）联合可弯曲真空辅助输尿管鞘（FV-UAS）与体外冲击波碎石术（ESWL）治疗肥胖患者1-2厘米下极肾结石（LPC）的疗效和安全性。
这项前瞻性随机研究纳入了149例患有1-2厘米LPC的肥胖患者。患者被分为两组：76例患者接受了RIRS联合FV-UAS治疗，73例患者接受了ESWL治疗。评估的参数包括无石率（SFR）、再次治疗率、并发症、手术时间以及通过视觉模拟量表（VAS）测量的疼痛强度。无石状态定义为术后4周计算机断层扫描显示无结石或残留碎片小于4毫米。
两组的基线特征具有可比性。RIRS组的SFR显著更高，达到86.8%，而ESWL组为63.0%（P = 0.034）。此外，RIRS组的再次治疗率显著更低，为5.2%，而ESWL组为24.7%（P < 0.001）。RIRS的平均手术时间明显更长，为65.3±6.4分钟，而ESWL为25.3±7.8分钟（P < 0.001）。RIRS组的并发症发生率为9.2%，ESWL组为6.8%，无统计学显著差异（P = 0.326）。根据改良的Clavien分类系统，所有并发症均被分类为I级或II级。两组在疼痛VAS评分和结石成分方面未观察到显著差异。
与ESWL相比，RIRS联合FV-UAS显示出更高的疗效，表现为更高的SFR和更低的再次治疗率，尽管手术时间更长。两种治疗方式的安全性相当。RIRS联合FV-UAS是治疗肥胖患者1-2厘米LPC的一种可行、有效且可重复的干预措施，具有显著的临床优势。
