RÉSUMÉ
Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.
RÉSUMÉ
PURPOSE: Intrarenal location of calculus significantly affects efficacy of SWL. In lower calyceal stone, its antigravitic location has been known to decrease success rate of SWL. In this study, renal calyceal stone is categorized according to its location and especially lower calyceal stone is further divided either with infundibulo-pelvic angle (IPA) greater than 90degreesor that with less than 90degrees. Difference of the treatment results were compared according to the location of stones. MATERIALS AND METHODS: 142 stones(upper calyx: 52, mid calyx: 11, lower calyx: 79) of 117 patients which had been treated by SWL since 1995 were retrospectively studied. The SWL machine used for treatment was EDAP-LT 01 Plus(piezoelectric mechanism with 3.5 MHz ultrasonic imaging system). Complete stone delivery was defined as state with no residual stone on KUB film. RESULTS: The mean stone size was 0.97+/-0.3cm and mean number of treatment session was 5.0+/-3.2. The complete stone delivery rate was 83%. There was no significant difference in number of session according to stone location(upper calyx: 4.4+/-1.9, mid calyx: 3.18+/-1.5, lower calyx: 4.8+/-2.4, p>0.05). The stone sizes of each calyx were 1.1+/-0.33cm, 0.8+/-1.5cm and 0.91+/-0.24 cm respectively. There were no siginificant differences in stone size among calyceal location(p>0.05). The complete stone delivery rate of each calyx were 88.5%(46/52), 90.9%(10/11), 74.7%(59/79) respectivey(p>0.05). Of the 79 lower calyceal stones, of which IPA was greater than 90degreesin 27 stones and less than 90degrees in 52 stones. There was no siginificant difference in size between two groups(0.86+/-0.16cm vs 0.9+/-0.25cm, p>0.05). The stone with greater infundibulo-pelvic angle had more session than that with lesser infundibulo-pelvic angle(4.9+/-2.2 vs 4.3+/-3.3, p=0.039). There was significant difference in complete stone delivery rate according to infundibulo-pelvic angle(96.3% - 26/27 vs 63.4% - 33/52, p=0.034). Also stone with less infundibulo-pelvic angle had inferior stone delivery rate compared with that of upper and mid calyceal stone. CONCLUSIONS: The lower calyceal stones with infundibulo-pelvic angle lesser than 90degreeshad significantly lower stone delivery rate compared with those with greater infundibulo-pelvic angle and upper and mid calyceal stone. In case of lower calyceal stone with infundibulo-pelvic angle less than 90degrees, other treatment such as PNL, pyelolithotomy must be considered as primary treatment modality.