軟式輸尿管雷射碎石預後以及其併發症：單一醫學中心經驗
倪雪雰、王樹吉、李建儀、洪晟鈞、盧嘉文、林嘉彥、陳卷書、王賢祥
臺中榮民總醫院外科部泌尿科
Outcome and possible complication of flexible ureteroscopy and laser lithotripsy for the ureteral stones and renal stones: a single center experience
Hsueh- fen Ni, Shu-Chi Wang, Jian-Ri Li, Sheng-Chun Hung, Jia-Wen Lu, Chia-Yen Lin, Chuan-Shu Chen, Shian-Shiang Wang
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: According to American Urological Association (AUA) and European Urological Association (EUA) guidelines, PCNL is now still the gold standard for large renal stones measuring 2 cm or greater. However for renal stones less than 2cm, the success rate for flexible ureteroscopy (fURS) seemed to be similar while comparing to PCNL. For patients with complicated underlying medical condition, the risk of long duration of anesthesia and the possibility of significant complications should also under consideration. In current study, we presented the outcomes and complication flexible ureterorenoscopic laser lithotripsy. We wonder the possibility over substitute PCNL with FURS as first line post failure of ESWL or PCNL over renal stones less then 2cm
Materials and Methods: Total 34 patients treated with flexible ureterorenoscopic laser lithotripsy due to renal stones, were enrolled. Whether patients received ESWL or lithotripsy management in advance was recorded. Stones size and location were recorded according to last image before fURS (including KUB or computed tomography), and the next morning post surgery. Whether further intervention was arranged for residual stone was also recorded. The total operation time and surgery related complications was under analysis
Results: Over 34 patients, including 16 female and 18 male, 18 of them were failure from previous intervention ( 4 ESWL, 2 PCNL, 8 ESWL combination with URSL,1ESWL combination with PCNL, 1 ESWL combination with PCNL and URSL). 8 patient have multiple urinary calculi, and the median size of urinary calculi was 12.1mm(ranging from 5mm to 30mm) Median operation time was 116.8 minutes. Residual stone noted from KUB followed up noted over 8 patient, and 2 of them received further ESWL.16 patients received abdominal CT before surgery, and only 2 of them over l000 in housfield unit. No correlation between housfield unit and residual stone size. No post operation fertile reported. Complication of ureter trauma related stricture noted in one patient may be ureter ischemia under long during using ureteric sheath.
Conclusions:
In this study, flexible ureteroscope present satisfying with few complication being reported, even within patient with larged size of renal stone or residual stones post ESWL, URSL or PCNL. For patients with complicated underlying medical condition, flexible ureteroscope may offer a different chance for both patient and surgeon