A Prospective, Multi-Institutional Study of Flexible Ureteroscopy for Proximal Ureteral Stones Smaller than 2 cm
A Prospective, Multi-Institutional Study of Flexible Ureteroscopy for Proximal Ureteral Stones Smaller than 2 cm
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DOI：
10.1016/j.juro.2014.07.002
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发表时间：
2015-01-01
影响因子：
6.6
通讯作者：
Matlagak, Brian R.
中科院分区：
文献类型：
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作者：
Hyams, Elias S.;Monga, Manoj;Matlagak, Brian R.
目的：柔性输尿管镜正迅速成为许多肾结石和输尿管结石患者的一线治疗方法。然而，目前对孤立输尿管近端结石患者的治疗结果的了解是有限的。因此，我们进行了一项输尿管镜下治疗小于2厘米的输尿管上段结石的前瞻性、多机构研究，以更好地确定与该方法相关的临床结果。材料和方法：前瞻性地确定了输尿管上段结石小于2厘米的成人患者。伴发同侧肾结石或既往输尿管支架置入术的患者被排除在研究之外。均行输尿管镜、输尿管内支架置入术、输尿管镜钬激光碎石术。输尿管入路鞘的使用、激光设置以及围手术期和术后管理的其他细节取决于外科医生的个人喜好。结果：71例患者中，男性44例(62%)，女性27例(38%)。平均年龄48.2岁。ASA(R)评分1分12例(16%)，2分41例(58%)，3分16例(23%)，4分2例(3%)。平均体重指数31.8 kg/m(2)，结石直径5~15 mm，平均7.4 mm，手术时间15~148分钟，平均60.3分钟。术中并发症2例(2.8%)，包括轻度输尿管损伤。术后并发症6例(8.7%)，其中尿路感染3例，尿潴留2例，闪发性肺水肿1例。结石排净率95.00%，结石直径<1 cm者100%。结论：输尿管上段结石<2 cm患者应用柔性输尿管镜治疗，临床效果良好，并发症发生率可接受。
Purpose: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.Materials and Methods: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.Results: Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA (R) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.Conclusions: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.