微創經皮腎造廔或雙鏡聯合手術治療腎囊腫合併腎結石: 單一醫學中心案例比較

蔡易辰¹、曾文歆^1,2、李高漢¹、劉建良³、黃冠華¹

台南永康奇美醫院 外科部 泌尿科¹；國立中山大學生物醫學研究所²；台南永康奇美醫院 外科部 泌尿腫瘤科³

Simultaneous Management of Renal Cysts and Stones: A Comparison of Percutaneous Nephrolithotomy and Endoscopic Combined Intrarenal Surgery

I-Chen Tsai¹、Wen-Hsin Tseng^1,2、Kau-Han Lee¹、Chien-Liang Liu³、Steven K. Huang¹

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

² Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

Introduction: Renal cysts and renal stones are the most common disease in urological surgeries. The prevalence of renal cysts is around 20-50%, which is increased by age. Two minimally invasive surgical techniques are applied recently: percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS). This study aimed to compare the safety and efficacy of these two procedures in the simultaneous management of renal cysts and stones by case experience.

Materials and Methods: We present a case series of 3 patients who underwent simultaneous treatment of renal cysts and stones with either PCNL or ECIRS at our center between 2018 and 2022. Surgical managements were determined by the stone and cyst location. Clinical features, calculus localization, complications, period of hospitalization and stone free rate with cyst resolution were evaluated.

Results: There were 2 patients underwent PCNL approach and 1 patient underwent ECIRS approach. In the PCNL group, parenchyma cysts complicated with lower calyx stone was noted. The one who received ECIRS approach had parapelvic cyst with obstruction of lower calyx and infundibulum. In PCNL group, we created 2 tracts for puncturing the cyst and stone in one patient, while the other had 1 tract to achieve stone clearance and decortication of the renal cyst. In ECIRS group, holmium laser ablation of the pararenal cyst wall by flexible ureteroscope was performed and the lower calyx stone was managed by supine PCNL (Galdakao modified supine Valdivia position). JJ stent was placed in all patients. All procedures were successful in achieving complete stone clearance and cyst puncture and drainage. There were no major intraoperative or postoperative complications.

Conclusions: Simultaneous treatment of renal cysts and stones with PCNL or ECIRS is a feasible and safe option that can achieve complete resolution of both conditions. However, the two methods had their own advantages for different type of cyst or stone location. The choice of procedure should be individualized based on the cyst and stone characteristics and surgeon preference. Further studies with larger sample sizes and longer follow-up are warranted to confirm these findings.