The efficacy and safety of single flexible ureteroscope vs. flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage

Abstract

Objective To evaluate the efficacy and safety of single flexible ureteroscope vs. flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage. Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017. All the patients undrwent contrast-enhanced CT, urinary tract imaging, ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst. The patients (38 males, 26 females)were divided into single flexible ureteroscope group [group A, 32 cases of patients, average age (54.2±6.6) years, unilateral or bilateral cystic patients: 19 cases/ 13cases, simple cyst of kidney or polycystic kidney: 24 cases/8 cases, average maximum diameter of the renal cyst (5.4±1.3)cm, combined with renal calculus: 8 cases, combined with hydronephrosis: 7 cases, 1 case who had the history of laparoscopic renal cyst decapitation, 1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B, 32 cases of patients, average age (52.3±9.3) years, unilateral or bilateral cystic patients: 21 cases/11 cases, simple cyst of kidney or polycystic kidney: 25 cases/7 cases. Average maximum diameter of the renal cyst (5.3±1.2)cm, combined with renal calculus: 9 cases, combined with hydronephrosis: 8 cases, 2 case who had the history of laparoscopic renal cyst decapitation, 1 case who had the history of percutaneous renal cyst puncture]. The double J stent was placed two weeks before the surgery into the body of patients. During the operation, the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J, 20 Hz), combined with ultrasound B in the monitoring, to find the suitable incision position. It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B. According to the standard, the result of operation wound be defined compared to before operation (success: shrink more than 80% or maximum diameter was smaller than 1 cm; improvement: shrink about 50%-79%; ordinary result: shrink about 30%-49%; failure: shrink smaller than 30%). Effective rate=(success cases+ improvement cases)/total cases. We compared the differences of two groups in the time, efficacy, safety and complication of surgery. Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery, after 8-30 months following-up, total operative complication rate was [8 cases(25%)vs. 1 case(3.1%)], success rate of operation in 6 month later [(20 cases(62.5%) vs. 28 cases(87.5%)]. Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P 0.05). Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively. Key words: Flexible ureteroscope; Ultrasonography guided; Renal cyst; Endogenous