Clinical application of Holmium laser with micro-percutaneous nephrolithotomy and flexibile ureteroscopy in the treatment of 10-20 mm lower renal calyx stones at different infundibulopelvic angles
DAN Chao1, WANG Li1, YAO Qisheng1, GONG Xiaoxin1, WANG Junlin1, YANG Yong1
Department of Urology and Andrology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, China
Abstract：Objective： To explore the efficacy and safety of micro-percutaneous nephrolithotomy (MPCNL) and flexibile ureteroscopy (FURS) in the treatment of 10-20 mm lower renal calyx stones at different infundibulopelvic angles (IPA). Methods： The clinical data of 90 patients with lower renal calyx stones admitted from August 2016 to January 2018 were enrolled in this study, and according to the IPA and the different surgical methods of patients, the patients were grouped. Among the patients with IPA >30°, 32 patients were included in the MPCNL group (group A) and 28 patients were included in the holmium laser lithotripsy of FURS group (group B). Among the patients with IPA <30°, 10 patients were included in the holmium laser lithotripsy of FURS group (group C) and 20 patients were included in the holmium laser with FURS combined with MPCNL (group D). The general data, surgical parameters, complications and stone-free rate were compared between the two groups. Results： There were no statistically significant differences in hemoglobin decrease degree, serum calcitonin level, postoperative pain VAS score, the blood transfusion rate, postoperative infection (Clavien I grade), mean postoperative hospital stay and stone-free rate between the group A and group B (P<0.05). The operation time in group A was significantly shorter than in group B (P<0.05). There were no statistically significant differences in hemoglobin decrease degree, serum calcitonin level, postoperative pain VAS score, postoperative infection (Clavien I grade), mean postoperative hospital stay between the group C and group D (P>0.05). The operation time in the group D was significantly longer than in the group A (P<0.05). The serum calcitonin level in the group D was higher than in the group A, but there was no significant difference (P>0.05). There was no significant difference in the postoperative fever between the two groups (P<0.05). The decreased degree of postoperative hemoglobin in the group D and group A was higher than in the group B, but there was no statistically significant difference (P>0.05).Conclusion： For IPA>30° of lower renal calyx stones, MPCNL and FURS have similar stone clearance rate and low incidence of complications, both of which are available options for treatment. For IPA≤30° lower renal calyx stones, FURS has limitations. The stone-free rate is also low in the treatment with RIRS lithotripsy alone. It is suggested that MPCNL or FURS+MPCNL can achieve better clinical treatment results.
但超, 王黎, 姚启盛, 龚小新, 王俊霖, 杨勇. 两种碎石术治疗不同肾盂漏斗部夹角的肾下盏结石[J]. 微创泌尿外科杂志, 2019, 8(5): 308-313.
DAN Chao, WANG Li, YAO Qisheng, GONG Xiaoxin, WANG Junlin, YANG Yong. Clinical application of Holmium laser with micro-percutaneous nephrolithotomy and flexibile ureteroscopy in the treatment of 10-20 mm lower renal calyx stones at different infundibulopelvic angles. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(5): 308-313.
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