Extracorporeal lithotripsy endoscopically controlled by ureterorenoscopy (LECURS): A new concept for the treatment of kidney stones-first clinical experience using digital ureterorenoscopes


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Purpose: To evaluate the feasibility and usefulness of extracorporeal lithotripsy endoscopically controlled by simultaneous flexible ureterorenoscopy (LECURS) and combined with Holmium laser lithotripsy for kidney stones surgery. Methods: Retrograde flexible ureteroscopy allowed stone visualization and intrarenal relocation when possible. Extracorporeal schock wave lithotripsy (ESWL) was performed under direct vision allowing constant focal zone adjustment for optimal stone fragmentation. Holmium laser lithotripsy was used simultaneously when necessary. Post-operative assessment included ultrasound at day one and abdominal CT scan 3 weeks later to evaluate for residual fragments. Results: Six patients with kidney stones were recruited including 3 with relative contraindication to ESWL. One patient had a stone beyond an infundibular stenosis and 2 had multiple stones in a horseshoe kidney with an uretero-pelvic junction (UPJ) stricture. A 100 % stone fragmentation rate was obtained. Post-operative ultrasound was normal in 5 patients and showed slight peri-renal infiltration in the other. One patient developed an obstructive pyelonephritis requiring antibiotics and changing a double J to a ureteral catheter. No other complications were noted. Three patients (50 %) were stone free after LECURS. Three patients underwent a second-look procedure for small (<3 mm) retained residual fragments. No damage was seen with the digital ureteroscopes, laser fibers or stone baskets. Conclusions: This initial experience with LECURS has shown to be feasible and safe. This opens the opportunity for further evaluation of this approach in order to improve outcomes of both approaches.
机译:目的:评估同时行输尿管镜(LECURS)内镜控制并结合Hol激光碎石术进行肾结石手术的体外碎石术的可行性和有效性。方法:逆行柔性输尿管镜可在可能的情况下进行结石可视化和肾内移位。体外肖克碎石术(ESWL)是在直视下进行的,可进行恒定的聚焦区调整以实现最佳的碎石效果。必要时同时使用激光碎石术。术后评估包括第一天的超声检查和3周后的腹部CT扫描以评估残余碎片。结果:招募了6例肾结石患者,其中3例ESWL相对禁忌。一名患者的结节狭窄以外有结石,马蹄肾中有多处结石,并有输尿管-骨盆连接处(UPJ)狭窄。获得了100%的碎石率。 5例患者的术后超声检查正常,另一例则显示肾脏轻度浸润。一名患者发生了阻塞性肾盂肾炎,需要使用抗生素并将双J换成输尿管导管。没有发现其他并发症。 LECURS后三例患者(50%)无结石。三名患者接受了第二眼检查,检查残留的小碎片(<3毫米)。数字输尿管镜,激光纤维或石篮未见损坏。结论:LECURS的初步经验已证明是可行和安全的。这为进一步评估该方法提供了机会,以改善两种方法的结果。



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