Comparison of the Efficacy of Ureteroscopy through a Flexible Vacuum-Assisted Ureteral Access Sheath with Tubeless-mini Percutaneous Nephrolithotomy for the Treatment of 2-3 cm Renal Calculi.

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

Urology Journal Pub Date : 2025-02-01 DOI:10.22037/uj.v22i.8368

Guanyun Deng, Kehua Jiang, Qing Wang, Wenbing Lu, Kunyuan Huang, Fa Sun

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Abstract

Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy(T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients of renal calculi with a maximum diameter of 2-3 cm treated between January 2022 to July 2024. Of these, 146 cases were treated with single use ureteroscopic lithotripsy through a FV-UAS while 124 cases were treated by tubeless PCNL (T-PCNL group) through 16F amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFR) were compared.

Results: There was no significant difference in the stone free rates（SFRs） between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI): 0.56-2.28, odds ratio (OR) = 1.13, P = .724; the SFRs at 1 month postoperatively were compared: 95% CI: 0.417-2.60, OR = 1.041, P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% CI: 0.355-1.055, OR = 0.612, P = .076; the SFRs at 1 month postoperatively were compared: 95% CI: 0.374-1.320, OR =.703, P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P=0.813, P=0.839, respectively). The surgical duration in the FV-UAS group was significantly longer (P<0.001). The decrease in postoperative hemoglobin(Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (P<0.001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

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软性真空辅助输尿管导管输尿管镜与无管微型经皮肾镜取石术治疗2 ~ 3cm肾结石的疗效比较。

目的：探讨软性真空辅助输尿管通路鞘（FV-UAS）联合一次性软性输尿管镜（FURS）与无管微型经皮肾镜取石术（T-PCNL）治疗直径2 ~ 3cm肾结石的疗效。材料与方法：本研究回顾性分析了2022年1月至2024年7月治疗的270例最大直径为2-3 cm的肾结石患者。其中经FV-UAS输尿管镜单次碎石146例，经16F amplatz鞘行无管PCNL （T-PCNL组）124例。比较围手术期指标和术后结石清除率（SFR）。结果：两种手术方式的结石游离率（SFRs）无显著差异。以残余肾结石直径小于4 mm为标准，比较两组术后3 d的SFRs: 95%可信区间（CI）： 0.56-2.28，优势比(OR) = 1.13, P = .724；术后1个月的SFRs比较：95% CI: 0.417-2.60, OR = 1.041, P = 0.931。以残余肾结石直径小于2 mm为标准，比较两组术后3 d的SFRs: 95% CI: 0.355-1.055, OR = 0.612, P = 0.076；比较术后1个月的sfr: 95% CI: 0.374-1.320, OR =。703, p = .271。两组患者全身炎症反应综合征（systemic inflammatory response syndrome， SIRS）发生率及术后镇痛需求比较，差异均无统计学意义（P=0.813， P=0.839）。结论：FV-UAS联合一次性输尿管镜和16F无管PCNL治疗2-3 cm肾结石均有较高的结石清除率。fv - uas辅助的FURS减少了出血和住院时间，而16F无管PCNL缩短了手术时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology Journal UROLOGY & NEPHROLOGY-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

6-12 weeks

期刊介绍： As the official journal of the Urology and Nephrology Research Center (UNRC) and the Iranian Urological Association (IUA), Urology Journal is a comprehensive digest of useful information on modern urology. Emphasis is on practical information that reflects the latest diagnostic and treatment techniques. Our objectives are to provide an exceptional source of current and clinically relevant research in the discipline of urology, to reflect the scientific work and progress of our colleagues, and to present the articles in a logical, timely, and concise format that meets the diverse needs of today’s urologist. Urology Journal publishes manuscripts on urology and kidney transplantation, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. Accordingly, original articles, case reports, and letters to editor are encouraged.