Evaluation of the efficacy and safety of flexible ureterorenoscopy in the treatment of renal calculi larger than 3 cm

doi:10.3877/cma.j.issn.1674-6899.2022.04.007

Abstract

Abstract:

Objective

To explore the feasibility and safety of flexible ureterorenoscopy(FURS) in the treatment of renal calculi larger than 3 cm and the surgical techniques in clinical practice.

Methods

52 cases of kidney stones larger than 3 cm in diameter were treated with FURS, including 42 cases of unilateral kidney calculi, 10 cases of bilateral kidney calculi, 24 cases of lower calyceal cast calculi, 5 cases of renal pelvis cast calculi with a stone diameter of 3.2-6.0 cm. FURS was performed in all patients after 10 days of unilateral or bilateral ureteral stent indwelling. KUB was performed on the first day and fourth week after operation to evaluate the effect of lithotripsy.

Results

The single operation success rate of 52 patients was 100%, the operation time was 60-305 min, and the average time was 135.4 min. there was no fever and serious complications after operation. The calculi clearance rate was 86.5% on the first day after operation, and 100% one month after operation.

Conclusions

For centers skilled in Furs, FURS is a relatively safe and effective clinical method for the treatment of kidney calculi larger than 3 cm.

Key words: Flexible ureterorenoscopy, Holmium laser, Massive renal calculi

Liang Cui, Chunlong Fu, Xiaofei Dai, Xun Zhang, Wanlin Jing, Xiaojun Sun, Jingmin Li. Evaluation of the efficacy and safety of flexible ureterorenoscopy in the treatment of renal calculi larger than 3 cm[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(04): 222-226.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2022.04.007

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2022/V15/I04/222

Figures/Tables 1

References 26

1	Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope[J]. British Journal of Urology International, 2015，95(7):1043-1044.
2	Tiselius HG, Ackermann D, Alken P, et al. Eau guidelines on urolithiasis[J]. European Urology, 2020，40(4):362-371.
3	Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: american urological association/endourological society guideline, part I[J]. Journal of Urology, 2016:1161-1169.
4	黄健. 中国泌尿外科和男科疾病诊断治疗指南(2019版)[M].北京：科学出版社，2020.
5	中华医学会泌尿外科学分会结石学组，中国泌尿系结石联盟. 经皮肾镜取石术中国专家共识[J]. 中华泌尿外科杂志，2020，41(6):401-404.
6	鄢羽中，周建辉，苏开德，等. 经皮肾镜取石术与输尿管软镜碎石术治疗上尿路结石疗效的Meta分析[J]. 现代泌尿外科杂志，2016，21(8):617-622.
7	Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery[J]. J Urol, 2013，189(2):580-584.
8	Deininaer S, Haberstock L, Todenhoefer T, et al. Single-use versus reusable ureteroscopes for retrograde intrarenal surgery (RIRS): systematic comparative analysis of physical and optical properties in three different devices[J]. European Urology Supplements, 2018，17(2):1398.
9	Proietti S, Dragos L, Molina WR，et al. Comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model[J]. Journal of Endourology, 2016:655-659.
10	Ventimiglia E, Godínez AJ, Traxer O, et al. Cost comparison of single-use versus reusable flexible ureteroscope: a systematic review[J]. Springer Journal，2020，46(1): 40-45.
11	Donaldson JFF. In the era of flexible ureteroscopy is there still a place for shock-wave lithotripsy: opinion: yes[J]. International braz j urol: official journal of the Brazilian Society of Urology, 2015，41(2):199-202.
12	曾国华，朱玮，钟文. 浅谈关于输尿管软镜术几个有争议的问题[J]. 临床泌尿外科杂志，2014, 29 (12):1041-1044.
13	Kaplan AG, Neisius A, Radvak D, et al. Evaluation of a novel single-use flexible ureteroscope[J]. Journal of Urology, 2016，15(3):1031.
14	周志均，李响. 输尿管软镜碎石术前预置双J管必要性的荟萃分析[J]. 中华泌尿外科杂志，2020，41(2):138-146.
15	何士尧，丁克文，吕建裕. 鞘外持续引流对输尿管软镜术后全身炎症反应综合征的预防作用[J]. 国际泌尿系统杂志，2020，40(2):193-194.
16	李强，王文佳，宋志强，等. 输尿管软镜钬激光碎石取石术应用于>2 cm上尿路结石的临床疗效和安全性[J]. 临床外科杂志，2020，28(2):116-119.
17	Shvero A, Herzberg H, Zilberman D, et al. Is it safe to use a ureteral access sheath in an unstented ureter[J]. Bmc Urology, 2019，19(1):1-4.
18	Zhong W, Leto G, Wang L, et al. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors[J]. Journal of Endourology, 2014，25-28.
19	Ludwig WW, Lim S, Dan S, et al. Endoscopic stone measurement during ureteroscopy[J]. Journal of Endourology, 2018，32(1):34-39.
20	Kallidonis P, Zsoy M, Kyriazis I, et al. Histological changes caused by the prolonged placement of ureteral access sheaths: an experimental study in porcine model[J]. European Urology Supplements, 2017，16(7):2590.
21	Wendt-Nordahl G, Mut T, Krombach P, et al. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors[J]. Urological Research, 2011，39(3): 185-188.
22	崔亮，李建民，殷小涛，等. 机器人辅助输尿管软镜手术系统的研制及试验评价[J]. 临床泌尿外科杂志，2018，33(7):511-515.
23	李建民，张增玉，赵建厂，等. 基于视觉反馈的输尿管软镜机器人运动补偿策略[J]. 天津大学学报(自然科学与工程技术版), 2021，54(7):738-749.
24	Rassweiler J, Fiedler M, Charalampogiannis N, et al. Robot-assisted flexible ureteroscopy: an update[J]. Urolithiasis, 2018, 46(1):69-77.
25	刘敏，高小峰. 铥光纤激光碎石基础研究和临床应用进展[J]. 中华泌尿外科杂志，2021，42(1):75-78.
26	Enikeev D, Grigoryan V, Fokin I, et al. Endoscopic lithotripsy with a superpulsed thulium-fiber laser for ureteral stones: a single-center experience[J]. Int J Urol, 2021，28(3):261-265.

[1]	Song Wan, Wei Hua, Hongmei Lan, Zhengxin Luo, Yueping Wan. Comparison of the clinical efficacy of holmium laser enucleation and transurethral resection of the prostate for benign prostatic hyperplasia [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 427-431.
[2]	Aimaier Aihemaiti·, Simayi Abulizi·, Peng Lei, Tayier Talaiti·, Xiaoan Zhang, Alimu Yalikun·, Bin Wen, Mao Tang. Clinical analysis of flexible ureteroscope with holmium laser incision for treatment of renal parapelvic cyst [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(04): 339-342.
[3]	Chundong Ji, Jianyu Wang, Kai Liu. Efficacy of modified holmium laser lithotripsy combined with stone basket for complex upper ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(01): 60-63.
[4]	Binbin Gong, Zhengyao Song, Yucheng Xu, Jianzhong Wang, Song Fan, Chaozhao Liang, Zongyao Hao. Application of 6.0/7.5 F ureteroscope combined with 200 μm holmium laser in the treatment of middle and lower ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 507-510.
[5]	Shoudong Yang, Dongming Xiao, Jie Situ, Cheng Hu, Hao Zhang. Clinical effect of occluder combined with holmium laser in the treatment of upper and middle ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 511-515.
[6]	Jidong Xu, Ning Jiang, Chuanyi Hu, Jing Zhang, Jingcun Zheng, Jian Chu, He Zhang, Xiangmin Zhang, Chuanmin Chu, Xingang Cui. Preliminary experiences of moses laser enucleation of the prostate (MoLEP) in the treatment of massive prostatic hyperplasia [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 484-487.
[7]	Xiaodong Hao, Lei Wang, Shuo Zheng, Hao Ding, Zijing Luo, Zhao Wang, Xuejun Xu, Zhe Xu. A retrospective study on retention time of double J tube and complications after ureteral holmium laser lithotripsy [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(05): 419-422.
[8]	Fan Yang, Xuwei Lu, Zhuifeng Guo, Yang He, Bingde Yin, Liang Qin, Hang Wang, Jiawen Wu. Clinical efficacy of presetting double J tube and using ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal pelvis calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(05): 423-427.
[9]	Shuxia Zhu, Kang Li, Yu Wang, Dan Yuan, Dongliang Liu. Clinical analysis of subcapsular renal hematoma after flexible ureteroscopic holmium laser lithotripsy [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 347-351.
[10]	Liang Chen, Rentao Zhang, Yingman Ding, Zhengquan Wang. Clinical experiences of ureteral stricture with calculi treated by flexible ureteroscope sheath dilatation [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 226-228.
[11]	Wei Zhang, Yong Lu, Yanbo Wang, Chuqi Lin. A prospective, randomized controlled trial of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 229-232.
[12]	Pingchang Cai, Mingjun Bai, Hong Gao, Jiangbo He, Dinghua Chen, Hongdong Zou, Xin Li, Cheng Hu, Tengcheng Li. Comparison of transurethral enucleation of the prostate and transurethral prostate high power holmium laser deburring for the treatment of benign prostatic hyperplasia [J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(06): 448-451.
[13]	Lei Wang, Wei Li, Xianyun Zhang, Qian Li, Fujin Jiang. Clinical efficacy of Sun's tip-flexible ureterorenoscopy combined with holmium laser lithotripsy for treatment of kidney stone less than 2 cm [J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(01): 40-43.
[14]	Qingfeng Tang, Xiaoke Huang, Chengwan Liu, Weiqi Lai, Liang Li. Clinical analysis of low-powered holmium laser enucleation of prostate for benign prostatic hyperplasia in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 37-41.
[15]	Zhongxiao Yan. Comparative study on transurethral holmium laser resection and plasmakinetic resection in treatment of benign prostatic hyperplasia in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 42-45.

Please choose a citation manager

Content to export