吸引清石鞘及奈芙輸尿管導入套管組於逆行性腎臟內視鏡手術的使用比較：
單一醫學中心之經驗
張朋暉1、林宜佳1,2，何肇晏1，朱懿柏1，葉志胤1，吳子翔1，陳宏恩1，仇光宇1,2，鄭以弘1，莊光達1,2，葉忠信1,2，邱文祥1,2，黃一勝1,2
新光吳火獅紀念醫院 泌尿科1
輔仁大學醫學系2
Comparison of Clear Petra and Navigator HD ureteral access sheath in retrograde intra-renal surgery: A single center experience
Peng-Hui Chang1, Yi-Chia Lin1,2, Chao-Yen Ho1, Yi-Bo Chu1, Chi-In Yeh1, Tzu-Shiang Wu1, Hung-En Chen1, Kuang-Yu Chou1,2, Yi-Hong Cheng1, Chung-Hsin Yeh1,2, Allen WS Chiu1, Thomas IS Hwang1,2
Department of Urology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan;
School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Purpose:
Retrograde intra-renal surgery (RIRS) is usually performed for renal stones 1-2 cm in size. Evolution of equipment such as guide-wires, ureteral access sheath and laser made this procedure more effective and safe. This retrospective study was a comparison of RIRS using Navigator HD ureteral access sheath (Boston Scientific, MA, USA) and Clear Petra ureteral access sheath (Well Lead, Taichung, Taiwan).
Materials and Methods:
From Jan. 2018 to Mar. 2019, 120 patients underwent retrograde intrarenal surgeries with holmium laser lithotripsy for renal stones in a single institution. Pre-operative and post-operative images were reviewed. Free of stone after the procedure was defined as stone < 0.5 cm in the 1st month without any adjunct procedure. The demographic, stone-free rate, duration of procedure, and complication were collected by a retrospective medical record review.
Results:
Among the 128 patients, Navigator HD access sheath was used in 109 patients and Clear Petra in 19 patients. The mean age was 56±13 years old and no significant difference between 2 groups (56±13 vs. 54±15, p=0.53). There was also no significant difference about gender distribution (61% male vs. 42% male, p=0.13), stone ≥ 2cm rate (33% vs. 53%, p=0.12), stone located at lower calyx rate (54% vs. 68%, p=0.32). The mean operative time and admission duration were 1h49m and 2.8±3.2 days in Navigator group and 2h17m and 4.4±4.05 days in Clear Petra group, p=0.05 and 0.12 respectively. Stone free rate was 64.4% in Navigator group and was 44.4% in Clear Petra group, p=0.167. Under subgroup analysis with stone ≥ 2cm, no stone free case was noted in Clear Petra group and about 1/3 case was stone free in Navigator group. Only 1 patient with severe complication (Clavien-Dindo grade IV) was noted in Navigator HD group.
Conclusion:
The results showed no significant difference about stone free rate between Navigator HD and Clear Petra access sheath. Decreased stone free rate is related to bigger renal stones.