Efficacy of single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery in the treatment of complex renal stones with intrarenal strictures
Objective To explore the efficacy and safety of single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery in the treatment of complex renal stones with intrarenal strictures.Methods Clinical data of 26 patients with complex renal stones and intrarenal strictures admitted in Jinhua Municipal Central Hospital from July 2019 to February 2022 were retrospectively analyzed.All patients had varying degrees of intrarenal strictures with hydronephrosis,and the stones were located in the upper calyx in 21 cases,middle calyx in 3 cases,and lower calyx in 2 cases.3 cases had bilateral renal stones,14 cases had multiple stones in the kidney and ureter,and 18 cases had staghorn stones.The stone size was(40.6±13.5)mm,CT attenuation value was(1 124.7±364.0)HU,and the stone size,tract length,obstruction,number of involved calyces,and essence of stone density score was(8.7±0.8).All cases underwent antegrade single-channel percutaneous nephroscopy plus retrograde ureteroscopy for stone fragmentation and removal.Results All 26 patients successfully completed the surgery,with the dilation of the narrowed passage and placement of the doble-J stent.The average operation time was(110.8±36.2)min.No severe bleeding or infection occurred intraoperatively or postoperatively.The incidence rates of postoperative Clavien-Dindo grade Ⅰ and Ⅱ complications were 7.7％(2 cases)and 15.4％(4 cases),respectively,while there were no complications of grade Ⅲ or higher.One month after operation,abdominal CT revealed a primary stone-free rate of 80.8％(21/26),and a secondary stone-free rate of 92.3％(24/26).The nephrostomy tube was removed 2-14 days postoperatively,and the double-J stent was removed 1-3 months postoperatively.During the 3-12 months of follow-up,no recurrence of obstruction was observed.Conclusion Single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery is effective and safe in treatment of complex renal stones with associated intrarenal strictures,which facilitates effective dilation of the narrowed passage and achieves a high stone-free rate with few complications.
万方数据
维普
