Analysis Of The Safety And Efficacy Of Combined Semirigid And Flexible Ureterorenoscopy Via Natural Orifice Transluminal For Renal Stones Larger Than 2 Cm

Objective:To evaluate the safety,efficacy and clinical value of combined semirigid and flexible ureterorenoscopy via natural orifice transluminal in the treatment of renal stones larger than 2 cm.Methods:Prospective analysis of clinical data of patients with renal stones larger than 2cm treated with combined semirigid and flexible ureterorenoscopy via natural orifice transluminal in the department of urology of the First Affiliated Hospital of Nanchang University from June 2019 to December 2019.All the patients in the study retained the ureteral stent(double J tube)on the affected side for 2 weeks before operation,and then underwent combined semirigid and flexible ureterorenoscopy via natural orifice transluminal to treat renal stones.During the operation,a large lumen ureteral access sheath(14/16 Fr,35cm)was used,most of the renal stones were crushed with semirigid ureterorenoscopy combined with a high-power holmium laser,and large-scale perfusion(up to 150 ml/min)was used to flush out stone fragments.Finally,flexible ureterorenoscopy was used to examine and remove the residual stones.The baseline data,operation status,stone-free rate(SFR)and postoperative complications were collected and analyzed.Results:A total of 28 patients were enrolled,and all patients could tolerate the ureteral stent placed 2 weeks before surgery.Five patients(17.9%)failed to undergo ureteral hardoscope combined with soft mirror surgery through the natural cavity due to the failure of 14/16 Fr ureteral sheath insertion,and the other 23 patients completed the operation successfully.The size of the stone is 23 to 47mm(mean,32.5±6.4mm),the operation time was 42 to 93min(mean,64.3 ± 13.4min),and the one-stage stone-free rate was 78.3%(18/23).Postoperative catheter retention time and postoperative hospital stay were both 1 day,and postoperative ureteral stent retention time was 2 to 12 weeks,with an average of(4.0±1.8)weeks.One patient had lowerurinary tract symptoms related to double J tube during the period of indwelling double J tube before operation.Surgical complications occurred in 3 patients,including 2 cases of ureteral injury(grade 1 and grade 2 respectively)and 1 case of double J tube related lower urinary tract symptoms.No long-term complications were found in the average follow-up of 6.1 months.Conclusion:Preliminary experience has shown that it is safe and effective to treat renal stones with a diameter greater than 2 cm by combined semirigid and flexible ureterorenoscopy surgery.It can be used as a choice for the treatment of large-load kidney stones and has certain clinical application value.