The Clinical Efficacy Of Modular Flexible Ureteroscope In The Treatment Of 1?2cm Lower Pole Renal Calculi And Correlation Analysis Of Lower Pole Pelvicaliceal Anatomy

ObjectiveThis study was to compare the effect of modular flexible ureteroscope(PolyScope)and digital flexible ureteroscope(URF-V)in the treatment of 1?2cm lower caliceal stones and evaluate the impact of lower pole pelvicaliceal anatomy on the succsee of flexible ureteroscopy and holmium laser Lithotripsy for 1?2cm lower pole renal stones to determine the anatomical factors affecting the efficacyMethodFrom October 2016 to September 2018,we evaluated 105 patients who underwent flexible ureteroscopy(PolyScope group?49 or URF-V group=56)for the diameter 1?2cm lower pole renal stones.Multivariate analysis was performed to determine whether infundibulopelvic angle(IPA),infundibular length(IL),and infundibular width(IW)affected stone clearance.Success was defined as either complete clearance or clearance with insignificant residual fragments 3 mm in size at 3-months follow-up noncontrast CT(NCCT)Result88.57%of the 105 patients were stone free status at the third month after retrograde intrarenal surgery(RIRS).The stone-free rate(SFR)of PolyScope group was 85.7%,and that of URF-V group was 91.1%(P>0.05),the average operation time of the PolyScope group(69.91 ±13.24min)was longer than URF-V group(57.67±2.24min)(P<0.001).In each case of cost,the PolyScope group and the URF-V group were 22275.51 yuan,26,342.85 yuan(P<0.001).There was no significant difference in the success rate of looking for calculus,hospital stay and complications(P>0.05).The unfavorable anatomic factors significantly on the efficacy of Modular flexible ureteroscope were narrow IW,steep IPA.On multivariate analysis,the IPA of<38.4g90,IW<8.75mm were unfavorable anatomical factors predicting the success of Modular flexible ureteroscope(P?0.013,P?0.008).The intraoperative and postoperative complications occurred in 23 patients(21.90%),including Clavien grade I in nineteen patients(18.10%),Clavien grade ?in two patients(1.90%),and grade IV in four patients(1.90%),almost all complications were minor,without urethral mucosal avulsion,rupture,perforation or postoperative ureteral strictureConclusionModular and Digital flexible ureteroscopy are both effective and feasible in the treatment of 1?2cm renal calculus,but combined design is a more cost-effective choice because of its durability and economy.The IPA and IW are negative risk factors for stone clearance after Modular flexible ureteroscope for 1?2cm lower pole renal stones.