Comparison of Semirigid and Flexible Ureteroscopy Results in Isolated Kidney Pelvis Stones Smaller than Two Centimeters

Yıl 2021, , 45 - 49, 28.04.2021

Osman Barut , Sefa Resim

https://doi.org/10.35440/hutfd.858497

Öz

Background: In our study, we aimed to compare the efficiency and reliability of using semirigid ureteroscopy (S-URS) and flexible ureteroscopy (F-URS) in the treatment of patients with stones smaller than 2 cm in isolated renal pelvis.
Materials and Methods: The data of 45 patients who underwent ureteroscopic stone treatment for isolated renal pelvis stones smaller than 2 cm were evaluated retrospectively. S-URS was routinely applied to all patients. If the stones can be accessed in the renal pelvis with S-URS, direct treatment with holmium laser was applied. If the stone was not accessible, F-URS was made. Groups were compared in terms of stone-free rates, operation times, hemoglobin reduction, and complications.
Results: S-URS was performed in 24 (53.3%) patients and F-URS in 21 (46.7%) patients. There was no significant difference between the two groups in terms of age, degree of hydronephrosis, mean stone size and stone side. Mean operation time was 64.62 ± 9.34 minutes in the S-URS group and 96.43 ± 14.26 minutes in the F-URS group (p=0.001). There was no statistically significant difference between the groups in terms of postoperative complications (p = 0.548). In the postoperative 1st day and 1st month follow-up, stone-free rates were 79.2% and 83.3% in the S-URS group, and 80.9% and 85.7% in the F-URS group, respectively (p = 0.768 and p = 0.574).
Conclusions: We observed that the use of S-URS and F-URS were very successful and safe methods in kidney stones smaller than 2 cm. S-URS is a safe treatment method that can be applied if the stone in the renal pelvis can be reached without any problem, especially in selected cases.

İki Santimetreden Küçük İzole Böbrek Pelvis Taşlarında Semirijid ve Fleksibl Üreteroskopi Sonuçlarının Karşılaştırması

Öz

Amaç: Çalışmamızda böbrek pelvisinde izole 2 cm’den küçük taşı olan hastaların tedavisinde semirijid ureteroskopi (S-URS) ve fleksibl üreteroskopi (F-URS) kulanımının etkinlik ve güvenilirliklerini karşılaştırmayı amaçladık.
Materyal ve Metod: İki cm’den küçük izole böbrek pelvis taşı nedeniyle üreteroskopik taş tedavisi uygulanan toplam 45 hastanın verileri retrospektif olarak değerlendirildi. S-URS tüm hastalara rutin olarak uygulandı. S-URS ile taşlara böbrek pelvisinde erişilebiliyorsa doğrudan holmiyum lazer ile tedavi uygulandı. Taş erişilebilir değilse F-URS yapıldı. Gruplar taşsızlık oranları, operasyon süreleri, hemoglobin düşüşü ve komplikasyonlar bakımından karşılaştırıldı.
Bulgular: 24 (%53,3) hastaya S-URS ve 21 (%46,7) hastaya F-URS yapıldı. İki grup arasında yaş, hidronefroz derecesi, ortalama taş boyutu ve taş tarafı bakımından anlamlı farklılık yoktu. Ortalama operasyon süresi S-URS grubunda 64,62±9,34 dakika, F-URS grubunda 96,43±14,26 dakika idi (p=0,001). Gruplar arasında postoperatif komplikasyonlar açısından istatistiksel olarak anlamlı fark yoktu (p=0,548). Postoperatif 1. gün ve 1. ay takipte taşsızlık oranları S-URS grubunda sırasıyla %79,2 ve %83,3 ve F-URS grubunda %80,9 ve %85,7 idi (p=0,768 ve p=0,574).
Sonuç: İki cm'den küçük böbrek taşlarında S-URS ve F-URS kullanımının oldukça başarılı ve güvenli yöntemler olduğunu gözlemledik. S-URS özellikle seçilmiş olgularda böbrek pelvisinde taşa sorunsuz bir şekilde ulaşılabiliyorsa uygulanabilecek güvenli bir tedavi yöntemidir.

Anahtar Kelimeler

Böbrek taşı, Semirijid, Fleksibl, Üreteroskopi

Kaynakça

• 1. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-74.
• 2. Afane JS, Olweny EO, Bercowsky E, Sundaram CP, Dunn MD, Shalhav AL, et al. Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr. J Urol. 2000;164(4):1164-8.
• 3. Liu DY, He HC, Wang J, Tang Q, Zhou YF, Wang MW, et al. Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones. Chin Med J. 2012;125(9):1542-6.
• 4. Slam J, Tricia D. Greene and Mantu Gupta: Treatment of proximal ureteral calculi: Holmium: YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol. 2002;167:1972-6.
• 5. Kumar A, Nanda B, Kumar N, Kumar R, Vasudeva P, Mohanty NK. A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: A single center experience. J Endourol. 2015;29:47-51.
• 6. Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for kidney and bladder stones. Turk J Urol. 2020;46(1) 104-112.
• 7. Cepeda M, Amón JH, Mainez JA, Rodríguez V, Alonso D, Martínez-Sagarra JM. Flexible ureteroscopy for renal stones. Actas Urol Esp. 2014;38(9):571-5.
• 8. Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol. 2011;25(7):1131-5.
• 9. Palmero JL, Castelló A, Miralles J, Nuño de La Rosa I, Garau C, Pastor JC. Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm. Actas Urol Esp. 2014;38(4):257-62.
• 10. Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol. 2013;31(6):1581-6.
• 11. Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG, et al. A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol. 2015;193(1):165-9.
• 12. Karadag MA, Demir A, Cecen K, Bagcioglu M, Kocaaslan R, Altunrende F. Flexible ureterorenoscopy versus semirigid ureteroscopy for the treatment of proximal ureteral stones: a retrospective comparative analysis of 124 patients. Urol J. 2014;11(5):1867-72.
• 13. Miernik A, Schoenthaler M, Wilhelm K, Wetterauer U, Zycz¬kowski M, Paradysz A, et al. Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2 cm: a bicentric prospective assessment. World J Urol. 2014;32:697-702.
• 14. Mir SA, Best SL, McLeroy S, Donnally CJ 3rd, Gnade B, Hsieh JT, et al. Novel stone-magnetizing microparticles: in vitro toxicity and biologic functionality analysis. J Endourol. 201;25(7):1203-7.
• 15. Tan YK, Best SL, Donnelly C, Olweny E, Kapur P, Mir SA, et al. Novel iron oxide microparticles used to render stone fragments paramagnetic: assessment of toxicity in a murine model. J Urol. 2012;188(5):1972-7.
• 16. User HM, Hua V, Blunt LW, Wambi C, Gonzalez CM, Nadler RB. Performance and durability of leading flexible ureteroscopes. J Endourol. 2004;18(8):735-8.
• 17. Multescu R, Geavlete B, Georgescu D, Geavlete P. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: a critical comparison. J Endorol. 2010;24:17-21.
• 18. Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, et al. Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol. 2010;24(12):1929-34.
• 19. Basillote JB, Lee DI, Eichel L, Clayman RV. Ureteroscopes: flexible, rigid, and semirigid. Urol Clin North Am. 2004;31:21-32.
• 20. Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol. 2012;26(1):52-7.
• 21. Süer E, Gülpinar Ö, Özcan C, Göğüş Ç, Kerimov S, Şafak M. Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm. Korean J Urol. 2015;56(2):138-42.
• 22. Atis G, Gurbuz C, Arikan O, Canat L, Kilic M, Caskurlu T. Ureteroscopic management with laser lithotripsy of renal pel¬vic stones. J Endourol. 2012;26:983-7.