Akopyan G N, Davronbekov Kh Kh, Tursunova F I, Shpot E V, Gazimiev M A, Rapoport L M, Glybochko P V
Research Institute of Urology and Human Reproductive Health, Department and Clinic of Urology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.
Urologiia. 2024 Sep(4):11-15.
Today it is urgent to introduce into clinical practice more advanced methods of kidney stone treatment with high indicators of their effectiveness and safety while minimizing the risk of repeated interventions. The goal of effective treatment of kidney stones is to completely rid the patient of stones and complaints, to eliminate organ dysfunction, using minimally invasive treatment methods that reduce the patients hospital stay and the risk of complications. However, there are only few studies comparing the clinical efficacy and safety of modern methods of surgical treatment of kidney stones 2 to 3 cm in size. Remote shockwave lithotripsy or retrograde intrarenal surgery is the treatment of choice for kidney stones up to 2 cm, and percutaneous nephrolithotomy is the treatment of choice for stones larger than 2 cm. Flexible ureterorenoscopy is not recommended as first-line treatment in patients with kidney stones >2 cm due to the high risk of reintervention, according to the RTC clinical guidelines. However, it can be performed successfully in centers with extensive experience with this technique. The advantages of retrograde intrarenal surgery are low trauma, low risk of complications such as bleeding and damage to adjacent organs, and shorter hospital stay. The efficacy of flexible ureterorenoscopy is significantly lower for stones larger than 3 cm, and for stones between 2 and 3 cm there are only a few studies, which do not allow a reliable judgment on the efficacy and safety of this technique.
To evaluate the efficacy and safety of flexible ureterorenoscopy in comparison with mini-percutaneous nephrolithotomy for kidney stones from 2 to 3 cm.
A prospective randomized study to determine the efficacy of methods of surgical treatment of kidney stones from 2 to 3 cm in size using flexible ureterorenoscopy and mini-PCNL was conducted at the Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University (Sechenov University) in Moscow. The study analyzed the results of the performed surgical interventions in patients with urolithiasis using flexible URS and mini-PCNL as an example from the point of view of their effectiveness and safety for kidney stones from 2 to 3 cm. The study utilized the results of 133 patients (including 64 patients after flexible URS and 69 patients after mini-PCNL). The mean size and mean density and location of the nodule between the groups were comparable and had no statistically significant differences. The effectiveness of the intervention in the form of complete absence of concretions, length of stay in the clinic, operative time, development of postoperative complications (bleeding, urinary tract infection) and Claviens surgical complication score were evaluated.
of the study. The duration of surgery was longer in the flexible URS group where it amounted to 69.9+/-9.3 minutes, in the mini-PCNL group the duration of surgery averaged 48.3+/-5.8 minutes (p=0.0001). The incidence of early postoperative complications in the flexible URS group was 6,2%, in the mini-PCNL group - 12,6%, which had statistically significant differences between the study groups at the level of p=0.001. The length of stay in the clinic was shorter in the flexible URS group, which averaged 2+/-1 days, while in the mini-PCNL group the length of stay was 5+/-2 days (p=0.0003). The frequency of concrement removal 3 months after the surgical intervention detected by computed tomography in the group of flexible URS was lower and amounted to 90,6%, in the group of mini-PCNL this index was at the level of 92,7% (p=0,06).
The results of this study demonstrate that flexible URS and mini-PCNL have a comparable success rate in removing concretions. Flexible URS reduces hospitalization time, causes fewer complications and can be used as an alternative in the treatment of kidney stones from 2 to 3 cm. Meanwhile, mini-PCNL has shown a higher percentage of effectiveness in getting rid of concretions 3 months after surgical intervention.
如今，迫切需要将更先进的肾结石治疗方法引入临床实践，这些方法应具有高有效性和安全性指标，同时将重复干预的风险降至最低。有效治疗肾结石的目标是使用微创治疗方法，使患者完全摆脱结石和不适，消除器官功能障碍，减少患者住院时间和并发症风险。然而，仅有少数研究比较了大小为2至3厘米的肾结石现代手术治疗方法的临床疗效和安全性。远程冲击波碎石术或逆行肾内手术是直径达2厘米肾结石的首选治疗方法，经皮肾镜取石术是直径大于2厘米结石的首选治疗方法。根据RTC临床指南，由于再次干预风险高，不建议将软性输尿管肾镜检查作为直径>2厘米肾结石患者的一线治疗方法。然而，在对此技术有丰富经验的中心可以成功进行。逆行肾内手术的优点是创伤小、出血和损伤邻近器官等并发症风险低、住院时间短。对于直径大于3厘米的结石，软性输尿管肾镜检查的疗效显著较低，对于直径在2至3厘米之间的结石，仅有少数研究，无法对该技术的疗效和安全性做出可靠判断。
评估软性输尿管肾镜检查与迷你经皮肾镜取石术治疗2至3厘米肾结石的疗效和安全性。
在莫斯科的I.M.谢马什克第一莫斯科国立医科大学（谢马什克大学）泌尿学与人类生殖健康研究所进行了一项前瞻性随机研究，以确定使用软性输尿管肾镜检查和迷你经皮肾镜取石术治疗大小为2至3厘米肾结石的手术治疗方法的疗效。该研究从软性输尿管肾镜检查（URS）和迷你经皮肾镜取石术对2至3厘米肾结石的有效性和安全性角度分析了尿路结石患者所进行手术干预的结果。该研究利用了133例患者的结果（包括64例软性输尿管肾镜检查术后患者和69例迷你经皮肾镜取石术后患者）。两组之间结节的平均大小、平均密度和位置具有可比性，无统计学显著差异。评估了以结石完全消失形式的干预有效性、临床住院时间、手术时间、术后并发症（出血、尿路感染）的发生情况以及Clavien手术并发症评分。
研究中。软性输尿管肾镜检查组的手术持续时间较长，为69.9±9.3分钟，迷你经皮肾镜取石术组的手术持续时间平均为48.3±5.8分钟（p = 0.0001）。软性输尿管肾镜检查组术后早期并发症发生率为6.2%，迷你经皮肾镜取石术组为12.6%，研究组之间在p = 0.001水平上有统计学显著差异。软性输尿管肾镜检查组的临床住院时间较短，平均为2±1天，而迷你经皮肾镜取石术组的住院时间为5±2天（p = 0.0003）。通过计算机断层扫描在软性输尿管肾镜检查组中检测到的手术干预3个月后结石清除频率较低，为90.6%，迷你经皮肾镜取石术组该指标为92.7%（p = 0.06）。
本研究结果表明，软性输尿管肾镜检查和迷你经皮肾镜取石术在结石清除方面成功率相当。软性输尿管肾镜检查可缩短住院时间，并发症较少，可作为2至3厘米肾结石治疗的替代方法。同时，迷你经皮肾镜取石术在手术干预3个月后结石清除有效率方面显示出更高的百分比。
