Randomized Trial of Stone Fragment Active Retrieval Versus Spontaneous Passage During Holmium Laser Lithotripsy for Ureteral Stones
Randomized Trial of Stone Fragment Active Retrieval Versus Spontaneous Passage During Holmium Laser Lithotripsy for Ureteral Stones
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DOI：
10.1016/j.juro.2009.11.013
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发表时间：
2010-03-01
影响因子：
6.6
通讯作者：
Winkler, Harry Z.
中科院分区：
文献类型：
--
作者：
Schatloff, Oscar;Lindner, Uri;Winkler, Harry Z.
目的：我们评估是否允许自发通过的小碎片是不同的，从完全术中提取在半刚性输尿管镜输尿管stone.Materials和方法：共60例接受输尿管镜和钬激光碎石术随机术中碎片检索（组1）或详尽的碎石术和自发的碎片驱逐（组2）。主要结果是计划外医疗和急诊室就诊的差异。其他结果是再住院，疼痛镇痛，时间完全恢复和30天的结石rate.Results：患者在第1组是年轻的（47比54岁，P = 0.05）。其他特征，包括结石负荷和部位、呈现方式、输尿管扩张和支架置入率，在两组之间没有差异。第2组患者的计划外访视率较高（3% vs 30%，OR 12.4，95% CI 1.8-80.3，p = 0.01），再住院率有升高的趋势（0% vs 10%，p = 0.24）和需要辅助治疗（0% vs 7%，p = 0.49），以及较低的结石清除率（100% vs 87%，p = 0.1）。并发症发生在1组1例和2组2例，包括2例术后发热和1例粘膜破坏的guides.Conclusions：在半刚性输尿管镜检查和钬激光碎石术中不积极回收碎片与计划外医疗访问的风险高于完全术中提取。它还显示了再住院率、残余结石和需要辅助手术的趋势。
Purpose: We assessed whether allowing spontaneous passage of small fragments is different from complete intraoperative extraction during semirigid ureteroscopy for ureteral stones.Materials and Methods: A total of 60 patients undergoing ureteroscopy and holmium laser lithotripsy were randomized to intraoperative fragment retrieval (group 1) or exhaustive lithotripsy and spontaneous fragment expulsion (group 2). The primary outcome was differences in unplanned medical and emergency room visits. Other outcomes were the rehospitalization, pain analgesia, time to complete recovery and 30-day stone-free rates.Results: Patients in group 1 were younger (47 vs 54 years, p = 0.05). Other characteristics, including stone burden and site, presentation mode, and ureteral dilation and stent placement rates, did not differ between the groups. Group 2 patients had a higher rate of unplanned visits (3% vs 30%, OR 12.4, 95% Cl 1.8-80.3, p = 0.01), a trend toward higher rates of rehospitalization (0% vs 10%, p = 0.24) and the need for ancillary treatment (0% vs 7%, p = 0.49), and a lower stone-free rate (100% vs 87%, p = 0.1). Complications developed in 1 group 1 patient and in 2 in group 2, including 2 with postoperative fever and 1 with mucosal undermining of the guidewire.Conclusions: Not actively retrieving fragments during semirigid ureteroscopy and holmium laser lithotripsy is associated with a higher risk of unplanned medical visits than complete intraoperative extraction. It also shows a tendency toward higher rates of rehospitalization, residual stones and the need for ancillary procedures.