Puppo P, Ricciotti G, Bozzo W, Introini C
Department of Urology, E.O. Galliera Hospital, Genova, Italy.
Eur Urol. 1999;36(1):48-52. doi: 10.1159/000019926.
In the post-ESWL period, ureteroscopy represented the solution giving a second choice in the treatment of ureteral calculi in case of failure of extracorporeal lithotripsy. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy can be chosen as the first approach for the treatment of ureteral calculi.
Between January 1994 and September 1997, 378 patients underwent ureteroscopy and endoscopic lithotripsy for ureteral stones with a miniscope associated with either a pneumatic or electropneumatic lithotriptor. Three different miniscopes were used: Olympus (8 Fr), Wolf (7 Fr) and Circon Acmi (7.7 Fr). 238 patients were male and 140 were female. The stones were localized in the upper tract of the ureter in 62 cases (16.4%), 96 (25.3%) in the mid ureter and 220 (58. 3%) in the lower ureter.
A complete stone fragmentation with spontaneous expulsion of the fragments occurred in 354 patients (93.6%). In 22 patients (5.8%) the stones were accidentally pushed up and successfully underwent ESWL. In 38 patients (10%) the fragments were completely removed by basket. A single J polyethylene catheter was placed in 21 (5.5%) and a JJ stent in 147 patients (38. 8%). The operative time ranged from 10 to 60 min, with an average time span of 32. In 22 cases (5.8%) an iterative ureteroscopy for stenosis or incomplete fragmentation was needed. Five cases (1.3%) of ureteral perforation were successfully treated by JJ stent, and only 1 case of ureteral avulsion (upper ureter) was treated by open surgery. In the attempt of overcoming an ureteral stenosis, we had 1 case (0.2%) of ureteral reimplantation. One patient (0.2%) underwent ureterolithotomy for an extremely narrow stenosis just before the ureteropelvic junction. No relevant complication was recorded in the postoperative period. Patients were dismissed after 1- 4 days (average 1.9). Up until now, no case of postoperative ureteral stricture has been observed, although we were not able to carry out a specific follow-up in all our patients.
Ureteroscopy with miniscopes has a high success rate (93.6%) with low morbidity and can be given as a primary approach in the management of ureteral calculi. In the lumbar ureter (especially in women) this technique can represent a good alternative to ESWL in the treatment of obstructing stones (which need stenting) or when the patient asks for a 'one-shot' treatment.
在体外冲击波碎石术（ESWL）后阶段，输尿管镜检查是在体外碎石失败时治疗输尿管结石的第二选择。本研究的目的是回顾一系列输尿管结石病例，其中输尿管镜联合内镜碎石术可被选作治疗输尿管结石的首选方法。
1994年1月至1997年9月期间，378例患者因输尿管结石接受输尿管镜检查及内镜碎石术，使用与气动或电动气动碎石器相关的微型输尿管镜。使用了三种不同的微型输尿管镜：奥林巴斯（8F）、狼牌（7F）和Circon Acmi（7.7F）。男性患者238例，女性患者140例。结石位于输尿管上段62例（16.4%），中段96例（25.3%），下段220例（58.3%）。
354例患者（93.6%）结石完全碎裂并碎片自然排出。22例患者（5.8%）结石意外上移并成功接受ESWL。38例患者（10%）通过网篮完全取出碎片。21例（5.5%）置入单J型聚乙烯导管，147例患者（38.8%）置入双J支架。手术时间为10至60分钟，平均32分钟。22例（5.8%）因狭窄或碎石不完全需再次进行输尿管镜检查。5例（1.3%）输尿管穿孔通过双J支架成功治疗，仅1例输尿管撕脱（上段输尿管）行开放手术治疗。在试图克服输尿管狭窄时，有1例（0.2%）进行了输尿管再植术。1例患者（0.2%）因输尿管肾盂交界处极度狭窄行输尿管切开取石术。术后无相关并发症记录。患者术后1 - 4天出院（平均1.9天）。到目前为止，尽管未能对所有患者进行具体随访，但未观察到术后输尿管狭窄病例。
微型输尿管镜输尿管镜检查成功率高（93.6%），发病率低，可作为输尿管结石治疗的首选方法。对于腰部输尿管结石（尤其是女性），在治疗梗阻性结石（需要置入支架）或患者要求“一次性”治疗时，该技术可作为ESWL的良好替代方法。
