Retrograde flexible ureteroscopy combined with visual minimally channel percutaneous nephrolithotomy in the treatment of staghorn calculi / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the safety and efficacy of retrograde flexible ureteroscopy combined with visual minimally channel percutaneous nephrolithotomy ( mPCNL) in the treatment of staghorn calculi.Methods A total of 23 patients with staghorn calculi were treated by retrograde flexible ureteroscopy combined with visual mPCNL from January to June, 2015.Of all the 23 patients, 20 were males and 10 were females ( ages ranged from 26 years to 79 years ) with mean age of 39.6 years.The calculi ranged from 3.5 cm to 6.5 cm [average (5.35 ±0.16) cm].Under general anesthesia or epidural anesthesia, the stones were shattered within the visual field through mPCNL firstly, then the stones in upper calyx, lower calyx and/or calyx which parallel with the percutaneous renal access were shattered by retrograde flexible ureteroscopy.F5 or F6 double-J tubes and nephrostomy tubes were routinely indwelled postoperatively.KUB and CT were performed at the first day postoperatively.A second-stage retrograde flexible ureteroscopy combined with visual mPCNL were performed for patients with residual stone fragments larger than 4 mm at the first week follow-up.Re-examinations with B-ultrasonography or CT was performed at the fourth week follow-up postoperatively to evaluate the stone free rate.Residual stones ≥ 4 mm were considered as clinical significance of residual stone.Results All the procedures were successful.The stone free rate was 91.3%(21/23) at one-stage and 100% (23/23) after the second stage.The operation time was 75-217 min [average (125 ±13.2) min] for one-stage procedure.Seven patients experienced with mild complications ( Clavien-Dindo classification gradeⅠ-Ⅱ) , and no patient experienced grade Ⅲ or above complications.Conclusions Retrograde flexible ureteroscopy combined with visual mPCNL are safe and effective for the treatment of staghorn calculi.