Clinical efficacy of flexible ureteroscopy lithotripsy in the management of 2-4 cm renal calculi
LUN Xiaolu1, WANG Yongchuan1,*, ZHOU Haijun1, DU Jing1, REN Anji1, WANG Kai1, WANG Xiaolong1, BI Yuxing1, SHAO Yi2
1Department of Urology, Weifang Hospital of Traditional Chinese Medicine, Shandong 261041, China; 2Department of Urology, Shanghai Jiaotong University Affiliated First People's Hospital
Abstract：Objective: To evaluate the efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy (fURL) in the treatment of renal calculi > 2 cm in diameter. Methods: The clinical data of 51 patients with unilateral renal calculi of 2-4 cm who underwent fURL from March 2014 to April 2019 in Weifang Hospital of Traditional Chinese Medicine were retrospectively analyzed. The statistical data included patient's age, gender, body mass index (BMI), the size and location of the renal calculi, the incidence of surgery-related complications (Clavien classification system, ureteral injury classification system), the times of fURL procedure by each patient, operation time, etc. Postoperative stone-free rate (SFR) was evaluated every 8-12 weeks. Results: All the patients with renal calculi in our group were successfully treated by fURL. Ureteral access sheath (UAS) was successfully inserted in 94% (48/51) of these patients. A total of 81 procedures were performed on 51 patients, with an average of 1.59 procedures per case. Twenty-six cases (51%, 2 cm < stone size ≤ 3 cm, CT value < 1 000 HU) were treated with a single procedure, and the postoperative SFR was 43.1% (22/51). Twenty-five cases (39.2%, 2 cm < stone size ≤ 3 cm, CT value > 1 000 HU) received two fURL procedures, and the postoperative SFR was 78.4% (40/51). Five cases (9.8%, 3 cm < stone size ≤ 4 cm, CT value > 1 000 HU) received three fURL procedures, and the total postoperative SFR was 86.3% (44/51) at last. The SFR of 13 special cases including solitary kidney, pelvic ectopic kidney, scoliosis, etc., was 84.6%. The average operation time was (72.0±11.8) min for the first fURL procedure, (51.2±6.7) min for the second and (37.6±7.9) min for the third respectively. The SFRs according to the location of renal calculi were 90% (9/10) in renal pelvis, 100% (4/4) in upper renal calices, 87.5% (7/8) in middle renal calices, 80% (8/10) in lower renal calices, and 84.2% (16/19) in renal pelvis and calices. The total incidence of postoperative complications was 25.5% (12/51). The complications of Clavien's grade 1-2 mainly included lumbago (3/51), fever (T > 38.5℃, 4/51), macroscopic hematuria (2/51), those of Clavien's grade 3 included "ureteral stone street" in one case of isolated kidney, one case of urinary sepsis and one case of ureteral stent displacement. The complications of ureteral injury included 3 cases of grade 0, 2 cases of grade 1 and 1 case of grade 3, 1 case of postoperative ureteral stenosis. According to the observation results, CT value < 1000 HU, renal pelvis, upper and middle renal calices were the main factors affecting SRF. Logistic regression model showed that the largest diameter of stones was more than 3 cm, the lower renal calyx was involved by stones, and multiple stones were the risk factors affecting SRF (P < 0.05). Conclusion: FURL is mini-invasive, reliable and safe, which could be used as an alternative therapy for some selected patients with 2-4 cm renal calculi, especially for extreme obesity renal calices, severe spinal deformity, isolated kidney renal calices with high PCNL risk, ectopic kidney or horseshoe, the CT value < 1 000 HU in renal pelvis, upper and middle renal calices, or cases who have strong desire to choose fURL.
伦晓璐, 王永传, 周海军, 都靖, 任安吉, 王凯, 王晓龙, 毕玉行, 邵怡. 输尿管软镜钬激光碎石术治疗2~4 cm肾结石临床疗效观察[J]. 微创泌尿外科杂志, 2020, 9(4): 245-249.
LUN Xiaolu, WANG Yongchuan, ZHOU Haijun, DU Jing, REN Anji, WANG Kai, WANG Xiaolong, BI Yuxing, SHAO Yi. Clinical efficacy of flexible ureteroscopy lithotripsy in the management of 2-4 cm renal calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(4): 245-249.
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