Sheathless and fluoroscopy-free retrograde intrarenal surgery:An attractive way of renal stone management in high-volume stone centers  

作　　者：Sarwar Noori Mahmood Hewa Toffeq Saman Fakhralddin 

机构地区：[1]University of Sulaimani College of Medicine,Kurdistan,Iraq [2]Sulaimania General Teaching Hospital,Sulaimania,Iraq

出　　处：《Asian Journal of Urology》2020年第3期309-317,共9页亚洲泌尿外科杂志（英文）

摘　　要：Objective:To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy(FURSL)for treating renal stones.Methods:Between May 2015 and May 2017,135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated.Our technique involved a semirigid ureteroscopic assessment of the ureter,and the guidewire was left in situ to railroad the flexible ureteroscope.A holmium laser was used to fragment and dust the stones;fragments were neither grasped nor collected.Results:The study population consisted of 135 patients including 85 males(62.96%)and 50 females(37.04%)with a mean age of 40.65 years(range:3-70 years)were evaluated.The mean stone size was 17.23 mm(range:8-41 mm).Complete stone-free status was achieved in 122(90.37%)patients and clinically insignificant residual fragments(CIRF)in two(1.48%),while residual stones were still present in 11(8.15%)patients.Postoperative complications occurred in 23(17.4%)cases and were mostly minor,including fever in 17(12.6%),pyelonephritis in four(3.0%),subcapsular hematoma in one(0.7%)and steinstrasse in one(0.7%).These complications were Clavien Ⅰ-Ⅱ,GⅠ in 17(12.6%)patients,GⅡ in five(3.7%),and Clavien Ⅲb in one(0.7%).No major complications were observed.Stone size2 cm,operative time ≥30 min,and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis(p<0.05).Conclusion:Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management,especially for stones under 2 cm in diameter.This process is a feasible option for avoiding sheath complications,which can protect surgeons from the negative effects of radiation.

关 键 词：Renal stone Retrograde intrarenal surgery Sheathless flexible ureterorenoscopy Fluoroless retrograde intrarenal surgery 

分 类 号：R699.2[医药卫生—泌尿科学]