Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

作     者：Ji-Qing Zhang Yong Wang Jun-Hui Zhang Xiao-Dong Zhang Nian-Zeng Xing Zhang Ji-Qing;Wang Yong;Zhang Jun-Hui;Zhang Xiao-Dong;Xing Nian-Zeng

作者机构：Department of Urology Beijing Chaoyang Hospital Capital Medicar University Beijing 100020 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2016年第129卷第17期

页      面：2067-2073页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Calyceal Diverticulum Calyceal Diverticulum Calculi Flexible Ureteroscope Percutaneous Nephrolithotonly Puncture Ultrasound 

摘      要：Background： Percutaneous nephrolithotomy （PCNL） is the most widely recommended treatment lbr calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy （FURS） is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy （UFURS） identifying diverticulum and the managenlent of calyceal diverticular calculi. Methods： A retrospective analysis was conducted on 24 patients who had calyceal diverticnlar calculi. In all 12 patients in tile UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the divenicular walls. Results： Puncture ofcalyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed lever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time （UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min）, stone-free rate （UFURS vs. PCNL, 9/12 vs. 10/12）, and rate of successful lithotripsy （UFURS vs. PCNL, 10/12 vs. 11/12） between the two groups （all P 〉 0.05）. Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group （2.7 ±1.2 vs. 6.2 ±1.5. P 〈 0.05）. Hospital stay in the UFURS group was significantly shorter than that in the PCNL group （3.4 ± 0.8 vs. 5.4 ± 1.0 days, P 〈 0.05）. All patients were symptom-free following surgery （UFURS vs. PCNL, 10/10 vs. 12/12）. Conclusio