TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: To assess the efficacy and safety of ureteroscopy-assisted Directional-eFlow (DeFlow) Doppler ultrasound-guided mini-endoscopic combined intrarenal surgery (mini-ECIRS) for large renal stones.
Methods: From May 2013 to April 2014, 16 patients with large renal stones of ≥2 cm in diameter underwent D-eFlow Doppler ultrasound-guided (ALOKAa7) mini-ECIRS in our institution. All mini-ECIRS procedures were performed under general anesthesia with patients in a modified-Valdivia position. Stones were fragmented using a Holmium laser, miniature nephroscope, and flexible ureteroscope, then extracted with a basket.
Results: The study included 16 patients (8 male, 8 female) with a mean age of 56.9 +/- 12.1 years. The collecting system was successfully accessed using a single tract in all cases. Mean stone size was 44.4 +/- 18.8 mm, including one complete staghorn calculus and two partial staghorn calculi. The mean total operative and mini-ECIRS times were 145.5 +/- 26 min and 96.0 +/- 17.1 min, respectively. The stone-free rate on postoperative Day 1 (POD1) was 81.2%. At one month, following auxiliary procedures, the stone-free rate increased to 93.7%. The mean hemoglobin decrease was 0.38 +/- 0.7 g/dl. Only minor intraoperative and postoperative complications occurred (fever ≥38.5, transfusion, and perirenal hematoma on POD1: 0%), including one case of post-discharge pyelonephritis.
Conclusions: Ureteroscopy-assisted Directional-eFlow Doppler ultrasound-guided mini-ECIRS was efficient and safe for treating large renal stones. The use of Directional-eFlow Doppler ultrasound guidance for selecting the puncture line into the renal parenchyma may minimize bleeding. However, treating larger renal stones with mini-ECIRS using a Holmium laser may result in a longer operative time associated with miniature nephroscope use.
Source of Funding: None
|Listen to an interview with Takaaki Inoue, one of the authors of this study.|
Presented by Takaaki Inoue,1 Takashi Murota,1 Makoto Taguchi,1 Tomoyuki Hayashi,1 Teruhisa Nishida,1 Shigenari Kawakita,1 Takashi Kawabata,1 Kouei Muguruma,1 Hidefumi Kinoshita,2 and Tadashi Matsuda1 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
1Takii-Hospital in Kansai Medical University, Japan
2Hirakata-Hospital in Kansai Medical University, Japan