逆行性腎臟內手術無使用輸尿管通道鞘之療效與安全性探討

陳建凱、石宏仁

彰化基督教醫院 外科部 泌尿科

Therapeutic efficacy and safety of retrograde intrarenal surgery without ureteral access sheath

Jian-Kai Chen, Hung-Jen Shih

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Purpose: The necessary of ureteral access sheath usage remains controversial. We compare the therapeutic effects and safety of retrograde intrarenal surgery (RIRS) without using ureteral access sheath (UAS) to RIRS with using UAS.

Materials and Methods: Patients with renal or ureteral stones received RIRS were included in this retrospective study. The patients were divided into 2 groups according to the with or without using of UAS. The pre-operative characteristics, intra-operative parameters and post-operative outcomes were recorded and compared.

Results: Total 50 patients were included in this study. Seventeen patients received RIRS without UAS and 33 patients received RIRS with UAS. All procedures were performed by a single urologist (HJ Shih). The indications of without UAS usage were failure for UAS insertion due to ureteral stricture or stone less than 1 cm. Pre-operative stenting was performed in 1 patient without UAS usage and 2 patients with UAS usage. Ureteral stricture was noted in 9 patients without UAS usage and ureteral stricture was noted in 2 patients with UAS usage. The mean size of the stones was 1.3 cm (7-24 mm) in patients without UAS usage and 2.7 cm (11-40 mm) in the patients with UAS usage. The mean operation time was 79 minutes (28-128 min) in the patients without UAS usage, and 98 minutes (34-184 min) in patients with UAS usage. Mild ureteral injury (grade 1) was noted in 3 patients with UAS usage. No postoperative febrile urinary tract infection was noted in all patients. One patient without UAS usage and 2 patients with UAS usage received extracorporeal shock wave lithotripsy (ESWL) within 3 months after RIRS. The stone-free rate was 93% in patients without UAS usage and 92% in patients with UAS usage.

Conclusions: RIRS without using UAS can be performed effectively and safely for patients with renal or ureteral stones. For patients with failure of UAS insertion due to ureteral stricture, RIRS without using UAS is the safety procedure if no resistance was encountered during flexible ureteroscopy inserted into ureter.