Risk Factors for Failure of Endoscopic Management of Stone-related Ureteral Strictures
Risk Factors for Failure of Endoscopic Management of Stone-related Ureteral Strictures
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DOI：
10.22037/uj.v18i.6697
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发表时间：
2022-03-01
期刊：
影响因子：
1.5
通讯作者：
Yasui, Takahiro
中科院分区：
文献类型：
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作者：
Sugino, Teruaki;Taguchi, Kazumi;Yasui, Takahiro
目的：探讨决定内镜治疗结石相关输尿管狭窄结果的因素。材料与方法：回顾性分析2016年1月至2020年4月因结石导致输尿管狭窄而接受内镜手术的患者资料。我们将内窥镜手术成功治疗的病例与失败的病例进行了比较。我们重点关注与治疗成功相关的因素，包括狭窄的原因和长度、狭窄的治疗方法、手术时间以及治疗前肾积水的持续时间。治疗成功定义为肾积水状态的改善。结果：19 名患者因结石相关输尿管狭窄而接受治疗。 12名患者（63.2%）肾积水得到成功改善。 7 名内镜治疗失败的患者出现输尿管镜碎石相关狭窄，而 3/12 (25.0%) 输尿管镜碎石相关狭窄患者和 7/12 (58.3%) 嵌顿结石相关狭窄患者通过内镜治疗成功治疗 (P = .004)。治疗失败的患者中狭窄长度 > 15 mm 的发生率显着高于治疗成功的患者（71.4% vs 16.6%，P = .046）。术中内镜观察显示，输尿管镜碎石相关狭窄的黏膜呈现缺血性表现，与阻生结石相关狭窄相比，狭窄长度相对较长（P = 0.13）。没有观察到治疗结果与内窥镜治疗方法（包括激光切割、球囊扩张或两者兼而有之）之间存在关联。结论：输尿管镜碎石术作为病因且狭窄长度>15 mm会影响内镜治疗输尿管狭窄的成功率。在这种情况下，应该在早期阶段考虑重建管理。
Purpose: To investigate factors determining the outcomes of endoscopic management for stone-related ureteral stricture. Materials and Methods: Data of patients who underwent endoscopic surgery for ureteral stricture due to stones from January 2016 to April 2020 were retrospectively analyzed. We compared cases successfully treated with endoscopic surgery with cases that resulted in failure. We focused on factors associated with treatment success, including cause and length of stricture, methods of stricture treatment, surgical time, and duration of hydronephrosis before the treatment. Treatment success was defined as improvement in hydronephrosis status. Results: Nineteen patients were treated for stone-related ureteral stricture. Hydronephrosis was successfully improved in 12 patients (63.2%). Seven patients with failed endoscopic management had ureteroscopic lithotripsy-related stricture, whereas 3/12 (25.0%) patients with ureteroscopic lithotripsy-related stricture and 7/12 (58.3%) patients with impacted stone-related stricture were successfully treated by endoscopic management (P = .004). The prevalence of stricture length > 15 mm was significantly higher in the patients with failed management than in the patients with successful management (71.4 vs 16.6%, P = .046). Intraoperative endoscopic observation demonstrated that the mucosa of the ureteroscopic lithotripsy-related stricture had ischemic appearance with relatively long stricture length (P = 0.13) compared to the impacted stone-related stricture. No association was observed between treatment outcome and method of endoscopic management, including laser incision, balloon dilation, or both. Conclusion: Ureteroscopic lithotripsy as a cause and stricture length > 15 mm could affect the success rate of endoscopic management of ureteral stricture. In such cases, reconstructive management should probably be considered in the early stages.