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Abstract：
OBJECTIVE: To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR).
METHODS: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05.
RESULTS: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF.
CONCLUSIONS: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.
METHODS: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05.
RESULTS: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF.
CONCLUSIONS: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.
摘要：
目的：评估逆行肾内手术（RIRS）治疗下极结石（LPS）的围手术期疗效及影响结石发生率（SFR）的因素。
方法：对来自20个中心的数据进行回顾性分析。纳入标准为成年患者，正常肾脏解剖，和LPS。排除标准为双侧手术，输尿管结石的伴随手术。SFR定义为单个残留碎片（RF）≤2mm，并在手术后3个月进行评估。进行了多变量逻辑回归分析以评估与RF相关的因素。统计显著性设定为p值<0.05。
结果：纳入2946例患者。平均年龄和结石大小为49.9岁10.19毫米，61.1%的病例有多个LPS。总手术时间和激光时间分别为63.89±37.65和17.34±18.39分钟，分别。平均住院时间为3.55天。需要输血的血尿和需要长时间使用抗生素的发热/尿路感染分别发生在6.1%和1695.7%的病例中,而脓毒症合并重症监护的患者占1.1%。在多变量分析中，多个结石（OR1.380），石材尺寸（或1.865），可重复使用的输尿管镜（OR1.414）与RF显着相关，而Thulium光纤激光（TFL）（OR0.341）和支架前（OR0.750）与RF相关的可能性较小。
结论：RIRS对平均直径为10mm的LPS具有安全性和有效性。该方法可以在单个较小结石的预支架患者中获得满意的SFR，特别是使用TFL。
方法：对来自20个中心的数据进行回顾性分析。纳入标准为成年患者，正常肾脏解剖，和LPS。排除标准为双侧手术，输尿管结石的伴随手术。SFR定义为单个残留碎片（RF）≤2mm，并在手术后3个月进行评估。进行了多变量逻辑回归分析以评估与RF相关的因素。统计显著性设定为p值<0.05。
结果：纳入2946例患者。平均年龄和结石大小为49.9岁10.19毫米，61.1%的病例有多个LPS。总手术时间和激光时间分别为63.89±37.65和17.34±18.39分钟，分别。平均住院时间为3.55天。需要输血的血尿和需要长时间使用抗生素的发热/尿路感染分别发生在6.1%和1695.7%的病例中,而脓毒症合并重症监护的患者占1.1%。在多变量分析中，多个结石（OR1.380），石材尺寸（或1.865），可重复使用的输尿管镜（OR1.414）与RF显着相关，而Thulium光纤激光（TFL）（OR0.341）和支架前（OR0.750）与RF相关的可能性较小。
结论：RIRS对平均直径为10mm的LPS具有安全性和有效性。该方法可以在单个较小结石的预支架患者中获得满意的SFR，特别是使用TFL。
