Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: Predictive factors for complications and success
Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: Predictive factors for complications and success
复制标题
DOI：
10.1016/j.aju.2013.04.008
复制
发表时间：
2013-06-01
影响因子：
1.5
通讯作者：
Abdel-Razzak, Omar M.
中科院分区：
文献类型：
--
作者：
Mursi, Khaled;Elsheemy, Mohammed S.;Abdel-Razzak, Omar M.
目的：分析和比较结石部位和大小、碎石方法以及经验水平对输尿管半硬镜治疗输尿管和肾盂结石的结果和并发症的影响。 患者和方法：2010年4月至2011年5月，90名患者接受了95次输尿管镜检查，使用7.5和9F半硬性输尿管镜，有或没有气动或激光碎石术。对围手术期的检查结果进行分析和比较。结果：结石的平均最长直径（SD）为11.8（4.5）mm。激光碎石术32例，气压弹道碎石术26例。35例手术中出现并发症，包括绞痛（2%）、血尿（1%）、结石移位（7%）、设备故障（5%）、通路故障（8%）、粘膜损伤（7%）、发热（2%）和外渗（3%）。 75 名患者 (83%) 成功取出结石。输尿管下段、中段、上段和肾盂的成功率分别为95%、77%、85%和53%。结论：半硬性输尿管镜可以安全地处理上段输尿管结石。肾盂结石的成功率较低，因此不是输尿管镜干预的主要指征。如果肾盂结石无法完全根除，则二次输尿管镜治疗可以改善随后的碱化或冲击波碎石术的结果。输尿管下段结石和小于10毫米的结石失败率明显较低。经验较少、结石尺寸 > 15 毫米和患者
Objective: To analyse and compare the effect of stone site and size, method of lithotripsy, and level of experience on the results and complications of semi-rigid ureteroscopy for ureteric and renal pelvic stones.Patients and methods: Between April 2010 and May 2011, 90 patients underwent 95 ureteroscopies, using 7.5- and 9-F semi-rigid ureteroscopes, with or without pneumatic or laser lithotripsy. The peri-operative findings were analysed and compared.Results: The mean (SD) longest diameter of the stones was 11.8 (4.5) mm. Laser lithotripsy was used in 32 cases and pneumatic lithotripsy in 26. There were complications in 35 procedures in the form of colicky pain (2%), haematuria (1%), stone migration (7%), equipment failure (5%), access failure (8%), mucosal injury (7%), fever (2%) and extravasation (3%). The calculi were successfully retrieved in 75 patients (83%). The success rate was 95%, 77%, 85%, and 53% in the lower, middle, upper ureter and renal pelvis, respectively.Conclusions: Upper ureteric stones can be managed safely with the semi-rigid ureteroscope. Renal pelvic stones are associated with a lower success rate, and thus they were not a primary indication for ureteroscopic intervention. The secondary ureteroscopic management of renal pelvic stones improved the results of subsequent alkalinisation or shock-wave lithotripsy if they could not be eradicated completely. The failure rate was significantly small in lower ureteric stones and stones of < 10 mm. Less experience, a stone size of > 15 mm and patients