雙鏡聯合碎石手術以及逆行性腎臟內手術針對高位複雜結石(大於兩公分)處理之預後分析比較

林崇裕、黃琮懿

高雄醫學大學附設醫院 泌尿部

Comparative Analysis of Simultaneous Supine Percutaneous Nephrolithotomy with Ureteroscopic Lithotripsy and Retrograde Intrarenal Surgery in the Management of Large Proximal Ureteral Calculi

Chung-Yu Lin, Tsung-Yi Huang

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Purpose: To compare the outcomes of simultaneous supine percutaneous nephrolithotomy (ssPCNL) with semi-rigid ureteroscopic lithotripsy(SR-URSL) and retrograde intrarenal surgery (RIRS)/flexible ureteroscopic lithotripsy(f-URSL) for treating large proximal ureteral calculus.

Materials and Methods: Between January 2017 and June 2021, all patients with large proximal ureteral stones (≥20 mm) who underwent simultaneous sPCNL with SR-URSL or RIRS at three medical centers were retrospectively included. Two surgical options were provided based on patients and doctors' decision. The intraoperative and postoperative results, including operating time, hospital stay, need for auxiliary procedures, and complications, were compared between the two groups. immediate stone-free clearance was defined as the absence of fragments or a single fragment of ≤3 mm on standard radiography after the surgery and delay stone-free clearance was defined as the absence of fragments 1 month after surgery.

Results: A total of 57 and 53 patients were included in ssPCNL and RIRS, respectively. The mean stone size was 24.1 mm and 23.6 mm and immediate stone-free rate (i-SFR) was 86% and 58.5% in Groups A and B, delay stone-free rate (d-SFR) was 87.7% and 77.4% in ssPCNL and RIRS, respectively. Prolonged hospitalization (P < 0.001) and better stone-free rate (87.7% vs. 77.4%) were observed in ssPCNL group. No significant difference regarding complications was observed between groups (P <0.001).

Conclusion: Simultaneous sPCNL with SR-URSL and retrograde intrarenal surgery (RIRS are both an effective treatment for large proximal ureteral stones. Even though larger stone size was observed, simultaneous sPCNL with SR-URSL results in significantly higher SFR without more complication but higher prolonged hospitalization compared to RIRS. Therefore, we recommend this technique for heavy stone burdens or high stone free rate.