Ureteroscopic management of intrarenal calculi

被引:111
作者
Fabrizio, MD [1 ]
Behari, A [1 ]
Bagley, DH [1 ]
机构
[1] Thomas Jefferson Univ, Jefferson Med Coll, Dept Urol, Philadelphia, PA 19107 USA
关键词
kidney; lithotripsy; calculi;
D O I
10.1016/S0022-5347(01)63531-6
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: To determine its potential role in stone therapy, we evaluated our experience with the ureteroscopic removal of intrarenal calculi in 100 patients. We review the indications, techniques, stone-free and overall success rates, and complications. Materials and Methods: From July 1994 to December 1996 ureteroscopic stone removal was attempted in 100 patients a mean of 52 years old who had renal calculi. Indications for treatment included concurrent ureteral stones in 56 cases, and failed extracorporeal shock wave lithotripsy, medical or percutaneous management as well as obesity and anatomical anomalies. There were 2 or more calculi in the affected kidney in 68 patients and stones greater than 6 mm. in 67. Treatment of intrarenal calculi was performed with flexible ureteroscopes, a laser or electrohydraulic lithotriptor and endoscopic graspers. The number and size of calculi were noted in each patient. Stone-free and overall success rates defined as 1 residual fragment less than 3 mm. were noted at 1 and 3-month followup visits. Results: The overall success rate was 89%. Ureteroscopic treatment of intrarenal calculi resulted in a 77% stone-free rate. Of the 23 patients with residual calculi 12 (52%) had a single residual fragment less than 3 mm. The targeted stone was removed or fragmented in 98 patients (98%) and no ureteral calculi remained postoperatively. As expected, the number and size of the original stones inversely correlated with the success rate. There were no intraoperative complications, and only 3 urinary tract infections and 3 fevers were noted postoperatively. Conclusions: The use of smaller diameter ureteroscopes, better working instruments and more effective lithotriptors allow calculi in all parts of the collecting system to be engaged and treated. Success rates throughout the whole collecting system are comparable to if not better than those of extracorporeal shock wave lithotripsy and percutaneous approaches.
引用
收藏
页码:1139 / 1143
页数:5
相关论文
共 41 条
[1]   CLINICAL-EXPERIENCE WITH FLEXIBLE URETEROPYELOSCOPY [J].
ABDELRAZZAK, OM ;
BAGLEY, DH .
JOURNAL OF UROLOGY, 1992, 148 (06) :1788-1792
[2]  
Bagley D, 1995, Tech Urol, V1, P25
[3]   FLEXIBLE URETEROPYELOSCOPY - DIAGNOSIS AND TREATMENT IN THE UPPER URINARY-TRACT [J].
BAGLEY, DH ;
HUFFMAN, JL ;
LYON, ES .
JOURNAL OF UROLOGY, 1987, 138 (02) :280-285
[4]   REMOVAL OF UPPER URINARY-TRACT CALCULI WITH FLEXIBLE URETEROPYELOSCOPY [J].
BAGLEY, DH .
UROLOGY, 1990, 35 (05) :412-416
[5]   THE FATE OF RESIDUAL FRAGMENTS AFTER EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY MONOTHERAPY OF INFECTION STONES [J].
BECK, EM ;
RIEHLE, RA .
JOURNAL OF UROLOGY, 1991, 145 (01) :6-10
[6]   OUTPATIENT FRAGMENTATION OF URETERAL CALCULI WITH MINI-URETEROSCOPES AND LASER LITHOTRIPSY [J].
BOLINE, GB ;
BELIS, JA .
JOURNAL OF ENDOUROLOGY, 1994, 8 (05) :341-343
[7]  
BRAY GA, 1989, CLIN N AM, V73, P176
[8]   COMPARISON OF FIRST GENERATION (DORNIER-HM3) AND 2ND GENERATION (MEDSTONE-STS) LITHOTRIPTORS - TREATMENT RESULTS WITH 13,864 RENAL AND URETERAL CALCULI [J].
CASS, AS .
JOURNAL OF UROLOGY, 1995, 153 (03) :588-592
[9]   1ST CLINICAL-EXPERIENCE WITH EXTRACORPOREALLY INDUCED DESTRUCTION OF KIDNEY-STONES BY SHOCK-WAVES [J].
CHAUSSY, C ;
SCHMIEDT, E ;
JOCHAM, D ;
BRENDEL, W ;
FORSSMANN, B ;
WALTHER, V .
JOURNAL OF UROLOGY, 1982, 127 (03) :417-420
[10]  
Das A, 1997, LASER SURG MED, V21, P198, DOI 10.1002/(SICI)1096-9101(1997)21:2<198::AID-LSM12>3.0.CO