超音波導引經皮穿腎腎臟鏡碎石術優先之策略應用於

雙鏡聯合碎石手術處理複雜性腎結石之單中心經驗

柳易揚、陳彥達、沈元琦、羅浩倫、陳建旭、王弘仁、張殷綸

吳彥廷、陳柏諺、李維菁、劉惠瑛、蔡佳宏、李偉嘉、莊燿吉

高雄長庚紀念醫院 泌尿科

Ultrasound Guided Percutaneous Nephrolithotomy First Strategy in Endoscopic Combined Intrarenal Surgery for Cmplex Renal Stones:

Single Center Experience

Yi Yang Liu, Yen Ta Chen, Yuan Chi Shen, Hao Lun Luo, Chien Hsu Chen, Hung Jen Wang

Yin Lun Chang, Yen Ting Wu, Po Yen Chen, Wei Chin Lee, Hui Ying Liu, Chia Hung Tsai

Wei Chia Lee, Yao Chi Chuang

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose: Nowadays, endoscopic combined intrarenal surgery (ECIRS), which combines percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) has become the mainstay of surgery for complex renal stones. Preliminary RIRS with endovision assisted percutaneous renal puncture was emphasized as the essential first step for ECIRS. However, RIRS may not be successful in about 20% of patients. Besides, it will be difficult for endovision assisted percutaneous renal puncture if the complex renal stones occupy ureteropelvic junction, renal pelvis or target renal calyx. Thus, we introduce totally X-ray-free ultrasound guided PCNL predominant ECIRS in Galdakao-modified supine Valdivia (GMSV) position for complex renal stones and prove the safety and efficacy.

Materials and Methods: We retrospectively reviewed 112 patients of complex renal stones (S.T.O.N.E score ≥ 9 or staghorn stone) who underwent single tract totally X-ray-free ultrasound guided PCNL predominant ECIRS in GMSV position from June 2021 to March 2024. All the perioperative parameters were collected for analysis. The residual stone was detected by the kidney-ureter-bladder X-ray plain film on the day after operation. The residual stone fragment < 4 mm was defined as stone free status. Besides, postoperative complications were also analyzed.

Results: In these 112 patients, mean age was 59.41 years-old. Total stone size was 4.75 cm (1219 mm²) in average. In stone complexity, mean S.T.O.N.E. scores was 9.91, including 95 patients (84.8%) with the scores ≧9. Besides, 83 patients (74.1%) had staghorn stones. Operation time was 99.5 minutes in average, and the success rate of renal access creation in the first attempt was 89.3%.. In the postoperative outcomes, 100 patients (89.3%) were stone free. Moreover, mean Hemoglobin drop was 0.93 g/dL. Complications include transient fever > 38℃ (N=10, 8.9%) and sepsis (N=2, 1.8%), which were subsided spontaneously or after medical treatment in a few days. There were no grade III or more severe complications by Clavien-Dindo classification.

Conclusion: Totally X-ray-free ultrasound guided PCNL predominant ECIRS in Galdakao-modified supine Valdivia (GMSV) position is feasible, safe and effective for patients with complex renal stones.