Zeinelabden Khaled Magdy, Abdelhalim Elsayed, Galal Mohamed, Abdelbaky Tarek, Nabeeh Hossam
Department of Urology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
BMC Urol. 2024 Dec 30;24(1):288. doi: 10.1186/s12894-024-01644-z.
Managing lower pole renal stones presents clinical challenges influenced by various factors such as stone size, location, and density. This study aims to assess the efficacy, safety, and stone-free rates of Flexible Ureteroscopy (FURS), Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini Percutaneous Nephrolithotomy (Mini PCNL) for treating lower pole renal hard stones (< 2 cm).
A prospective single-centre comparative study was conducted on 414 adult patients with primary lower pole renal hard stones. Patients were evenly distributed into three groups: Flexible Ureteroscopy (FURS) utilizing holmium laser lithotripsy, Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini PCNL employing holmium laser lithotripsy.
Statistically significant differences with P value < 0.001 were observed among groups in stone-free rates, hospital stay, radiation exposure, operative duration, auxiliary treatments, and overall cost. No statistically significant differences were found in demographic data with P value = 0.245 or complication rates with P value = 0.611 among the groups. At the 2-week follow-up, stone-free rates were 90.2% for Flexible Ureteroscopy which was comparable with mini PCNL and both were significantly higher than ESWL 61.5%.
Mini PCNL and Flexible URS demonstrated comparable stone-free rates for moderate-sized, hard lower pole renal stones, surpassing ESWL. However, Mini PCNL showed longer operative times, increased radiation exposure, and elevated risks of complications and morbidity compared to Flexible URS. Considering these factors, Flexible URS might be recommended in those types of stones.
Our study has been approved by local ethical committee Kafrelsheikh university (KFSIRB20069) on 30/10/2023 and by clinical trials (NCT06120257) on 15/12/2023.
处理下极肾结石存在临床挑战，受结石大小、位置和密度等多种因素影响。本研究旨在评估软性输尿管镜检查（FURS）、体外冲击波碎石术（ESWL）和微创经皮肾镜取石术（Mini PCNL）治疗下极肾硬结石（<2厘米）的疗效、安全性和无石率。
对414例患有原发性下极肾硬结石的成年患者进行了一项前瞻性单中心对比研究。患者被平均分为三组：使用钬激光碎石术的软性输尿管镜检查（FURS）组、体外冲击波碎石术（ESWL）组和使用钬激光碎石术的微创经皮肾镜取石术（Mini PCNL）组。
在无石率、住院时间、辐射暴露、手术时长、辅助治疗和总成本方面，各组间观察到具有统计学显著差异（P值<0.001）。在人口统计学数据方面（P值=0.245）以及各组间并发症发生率方面（P值=0.611），未发现具有统计学显著差异。在2周随访时，软性输尿管镜检查的无石率为90.2%，与微创经皮肾镜取石术相当，且两者均显著高于体外冲击波碎石术的61.5%。
对于中等大小的下极肾硬结石，微创经皮肾镜取石术和软性输尿管镜检查的无石率相当，均超过体外冲击波碎石术。然而，与软性输尿管镜检查相比，微创经皮肾镜取石术显示出更长的手术时间、更高的辐射暴露以及更高的并发症和发病风险。考虑到这些因素，对于此类结石可能推荐使用软性输尿管镜检查。
我们的研究于2023年10月30日获得当地伦理委员会卡夫勒谢赫大学（KFSIRB20069）批准，并于2023年12月15日获得临床试验（NCT06120257）批准。
