軟性腎盂尿管鏡を使用した経尿道的アプローチによる腎尿管結石破砕の経験

Abstract

Disintegration of urinary stones by electrohydraulic lithotripsy (EHL) under transurethral flexible nephro-ureteroscopy was performed for 39 renal and ureteral stones in 38 patients. The use of a ureteral guide tube facilitated the endoscopic manipulation and allowed the endoscope to access the stones in all cases except for two with a severe ureteral stricture. Thirty-seven of the 39 stones (94.9%) were successfully disintegrated and 35 stones (89.7%) were distracted. And 33 stones were completely excreted within 6 months (average, 27.9 days). Complications including ureteral perforation in 3 cases, one of whom required open ureterolithotomy, urinary extravasation in one, failure of removing the ureteral stent in one and perirenal abscess in one who underwent surgical incision. The transurethral flexible endoscope provides a clear vision in the whole urinary tract up to the renal calyx with a minimal complication. This technique could be used as a non-invasive treatment of urolithiasis adjunct to extracorporeal shock wave lithotripsy (ESWL), and also it could be an effective measure for other urological diseases such as the upper urinary tract tumors.