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Asian Journal of Urology, 2018, 5(4): 264-273    doi: 10.1016/j.ajur.2018.06.005
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Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis
María Rodríguez-Monsalve Herrero,Steeve Doizi,Etienne Xavier Keller,Vincent De Coninck,Olivier Traxer()
Department of Urology, Tenon Hospital, Assistance-Publique H?pitaux de Paris, Paris, France
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Abstract: 

During the past 3 decades, the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy. The development of this instrument as well as ancillary equipment such as baskets, graspers, and others, and improvements in lithotripsy with Holmium: YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors. The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

Key words:  Ureteroscopy    Retrograde intrarenalsurgery    Endourology    Urolithiasis
收稿日期:  2018-04-13      修回日期:  2018-05-05           出版日期:  2018-10-20      发布日期:  2018-11-19      整期出版日期:  2018-10-20
引用本文:    
. [J]. Asian Journal of Urology, 2018, 5(4): 264-273.
María Rodríguez-Monsalve Herrero,Steeve Doizi,Etienne Xavier Keller,Vincent De Coninck,Olivier Traxer. Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis. Asian Journal of Urology, 2018, 5(4): 264-273.
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http://www.ajurology.com/CN/10.1016/j.ajur.2018.06.005  或          http://www.ajurology.com/CN/Y2018/V5/I4/264
AUA/ES recommendation Grade of recommendation EAU recommendation Level of evidence
Surgical management of distal uretal stones >10 mm Strong recommendation >10 mm -
1. URS 1. URS
2. SWL 2. SWL
<10 mm Strong recommendation <10 mm URS or SWL -
1. URS
2. SWL
URS for cystine or uric acid ureteral stones Expert opinion
Surgical management of proximal uretal stones >10 mm 1. URS Strong recommendation >10 mm -
1. URS
2. SWL
<10 mm 1. URS Strong recommendation <10 mm -
1. URS
2. SWL
For severe obesity, URS is a more promising option than SWL. 2b
Use PCNL for ureteral stones as an alternative when SWL is not indicated or has failed or when URS is impossible. -
Table 1  AUA and EAU guidelines on ureteral stones.
AUA/ES Recommendation Grade of recommendation EAU recommendation Level of evidence
Surgical management of renal stones, lower pole excluded <10 mm
SWL or fURS
10-20 mm
SWL or fURS
>20 mm
1. PCNL
2. fURS
No SWL as first-line treatment
Strong recommendation <10 mm
1. SWL or fURS
-
2. PCNL
Strong recommendation 10-20 mm
SWL or endourology (fURS or PCNL)
-
Strong recommendation >20 mm
1. PCNL
-
Strong recommendation 2. SWL or fURS
Strong recommendation
Surgical management of renal stones, lower pole <10 mm
SWL or fURS

10-20 mm
fURS or PCNL
No SWL as first-line treatment
>20 mm
1. PCNL
2. fURS
No SWL as first-line treatment
Strong recommendation <10 mm
1. SWL or fURS
-
2. PCNL
Moderate recommendation 10-20 mm
SWL or fURS or PCNL
-
Strong recommendation
Strong recommendation >20 mm
1. PCNL
-
Strong recommendation
Strong recommendation
2. fURS or SWL
Use fURS if PCNL or SWL are not an option (even for stones >2 cm)
-
Table 2  AUA and EAU guidelines on kidney stones.
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