Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones2 cm: a bicentric prospective assessment
| Autor: | Martin Schoenthaler, Arkadiusz Miernik, Andrzej Paradysz, Marcin Zyczkowski, Konrad Wilhelm, Piotr Bryniarski, Ulrich Wetterauer |
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| Rok vydání: | 2013 |
| Předmět: |
Nephrology
Adult Male medicine.medical_specialty Urology medicine.medical_treatment Lithotripsy Kidney Calculi Young Adult Ureter Imaging Three-Dimensional Internal medicine medicine Ureteroscopy Humans Percutaneous nephrolithotomy Aged Retrospective Studies medicine.diagnostic_test business.industry Perioperative Equipment Design Middle Aged medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Fluoroscopy Ureteroscopes Kidney stones Female business Follow-Up Studies |
| Zdroj: | World journal of urology. 32(3) |
| ISSN: | 1433-8726 |
| Popis: | The international guidelines on urolithiasis state that the percutaneous approach is superior for kidney stones ≥20 mm. Nevertheless, several groups have reported high stone-free rates (SFRs) with low morbidity for ureteroscopic treatment of calculi >15 mm. We hereby describe a new technique including the combined use of semirigid and flexible ureteroscopy via a large ureteral access sheath (UAS). The proposed technique includes (a) preoperative ureteral stenting, (b) use of a large lumen UAS (14/16F, 35 cm), (c) use of a semirigid ureteroscope, (d) holmium laser lithotripsy, (e) passive and (f) active fragment extraction, and finally, the removal of caliceal stones (g) using a flexible scope. We conducted a prospective outcome analysis for 38 patients treated at two tertiary university centers. Perioperative data were as follows: median cumulative stone size 24.5 mm (20–60), median operating time 95 min (50–205), post-operative ureteral stenting (2–35 days) in 33 patients (86.8 %), Clavien complications 2 and 3 in 7.9 %, primary SFR 63.2 %, and overall computed tomography (CT) controlled SFR after 3 months 81.8 % (including staged procedures). No late complications were observed. The combined use of semirigid ureteroscopy and an UAS further develops the endoscopic treatment of kidney stones. This is the first series of this kind that confirms high SFRs by CT. The approach has significant advantages: Superior irrigation and outflow enhance both vision and stone clearance, and multiple ureteral passages without putting the ureter at injury risk. These encouraging results make this modality an appealing alternative to percutaneous nephrolithotomy. |
| Databáze: | OpenAIRE |
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