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The role of ureteroscopy for treatment of staghorn calculi: A systematic review |
Etienne Xavier Kellerab,c,Vincent De Coninckab,d,Steeve Doiziab,Olivier Traxerb,*()
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a Sorbonne Université, Service d’Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France b Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France c Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland d Department of Urology, AZ Klina, Brasschaat, Belgium |
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Abstract Objective: To define the role of ureteroscopy for treatment of staghorn calculi. Methods: A systematic review was conducted using the Scopus and Medline databases. Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included. Results: In five studies on ureteroscopic monotherapy, stone-free rate (SFR) ranged from 33% to 93%, with a maximum four ureteroscopy sessions per patient and no major complications. Endoscopic combined intrarenal surgery (ECIRS) was compared with percutaneous nephrolithotomy (PNL) in two studies and reached significantly higher SFR (88%-91% vs. 59%-65%) and lower operative times (84-110 min vs. 105-129 min). The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%-89%. One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi, with a SFR of 92%. Conclusion: Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi. Ureteroscopy is also particularly suitable for clearance of residual stones. In specific cases, ureteroscopy may become the sole applicable therapeutic option to staghorn calculi. Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
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Received: 02 June 2019
Available online: 05 December 2019
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Corresponding Authors:
Olivier Traxer
E-mail: olivier.traxer@aphp.fr
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Staghorn calculi. (A) Complete staghorn calculi occupy the whole pyelocaliceal cavities; (B) Partial staghorn calculi have at least one calyceal branch attached to the renal pelvis.
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Flow chart of the literature search.
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Combined approach to staghorn calculi. (A) Complete staghorn calculi may preclude antegrade access to the pyelocaliceal cavities; (B) Primary retrograde approach allows for stone debulking by the means of flexible ureteroscopy with laser lithotripsy; (C) Antegrade guidewire insertion becomes possible after sufficient stone debulking. The arrow indicates the typical percutaneous way of insertion of a guidewire; (D) Synergistical use of the antegrade and retrograde approach. Flexible ureteroscopy is used for calyces that would be difficult to access with a nephroscope, alleviating the need for additional percutaneous tract dilations.
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Topic | Patient position | Risks and limitations | Anesthesia | Prone | Accidental extubation and endotracheal tube kinking, impaired ventilation and circulation, neck, eyeball and peripheral plexus injuries | Puncture | Supine | Restricted area of puncture, greater amplitude of respiratory movements of the kidney (debated), more challenging upper pole calyceal puncture (debated), longer tract length with decreased nephroscope mobility (debated) | Navigation | Supine | Restricted working space, rapid intrarenal pressure loss and collapse of pyelocaliceal cavities (debated, may become an advantage) | Stone extraction | Prone | Lower probability for spontaneous stone evacuation over the percutaneous access sheath (exception: Use of the vacuum cleaner effect) | Ureteroscopy | Prone | Restricted working space, unusual navigation (inverted anatomy), potentially higher risk for stool contamination |
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Risks and limitations of patient positioning for combined approaches to staghorn calculi (expert opinion).
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