Serrano Pascual Alvaro, Fernández Fernández Eldiberto, Burgos Revilla Francisco Javier, Platas Sancho Arturo, Diez-Yanguas Iza Juan, Páramo de Santiago Pedro, Lovaco Castellano Francisco
Unidad de Litotricia, URSA, Madrid, España.
Arch Esp Urol. 2002 May;55(4):405-21; discussion 421-2.
To present the results achieved by rigid transurethral ureteroscopy for the management of ureteral calculi over a period of 10 years.
From January 1991 to November 2000, 735 rigid transurethral ureteroscopy procedures for ureteral calculi were performed in our Lithotripsy Unit. The rigid ureteroscopes utilized ranged from 9.5-11.5 F. There was a higher prevalence of male patients (63%). The mean age was 49.9 years. Calculi were more frequently localized in the pelvic ureter (74.2%). The mean maximum diameter of the calculi was 9.6 mm and caused moderate to severe uropathy in 78.6% of the cases and functional impairment in 3.7% of the cases. After performing ureteroscopy, a double-J catheter was left indwelling in 65.8% of the patients. The patients were discharged from hospital usually 12-18 h after the endoscopic procedure.
Of the 735 ureteroscopies performed, satisfactory results were achieved in 676 cases (92%); stone resolution was not achieved in 59 cases. For complete resolution of the calculi, mechanical or electrokinetic fragmentation was used in a high proportion of patients (56.3%). Removal of the stone or stone fragments was mainly by forceps (79.7%); the Dormia basket was used in 18.2% of the cases. The complications occurred during or immediately after the procedure and were minor (10.7%), although there were 3 patients with major complications (2 ureteral eversion and one case of ureteral avulsion).
In our view, rigid transurethral ureteroscopy is a useful, safe and efficient technique in the treatment of calculi in the pelvic ureter, and in selected cases of calculi in the sacral or lumbar level, after failed ESWL. Rigid transurethral ureteroscopy achieves excellent resolution and the complications are scanty.
介绍经尿道硬性输尿管镜治疗输尿管结石10年所取得的成果。
1991年1月至2000年11月，我们的碎石治疗中心共进行了735例经尿道硬性输尿管镜治疗输尿管结石的手术。所使用的硬性输尿管镜型号为9.5 - 11.5F。男性患者比例较高（63%）。平均年龄为49.9岁。结石更常见于盆腔段输尿管（74.2%）。结石平均最大直径为9.6mm，78.6%的病例导致中度至重度尿路病变，3.7%的病例出现功能损害。输尿管镜检查后，65.8%的患者留置双J导管。患者通常在内镜手术后12 - 18小时出院。
在735例输尿管镜检查中，676例（92%）取得了满意的结果；59例未达到结石清除效果。为实现结石的完全清除，大部分患者（56.3%）采用了机械或电动碎石术。结石或结石碎片的取出主要通过钳子（79.7%）；18.2%的病例使用了多尔米亚网篮。并发症发生在手术期间或术后即刻，且为轻微并发症（10.7%），不过有3例患者出现了严重并发症（2例输尿管外翻和1例输尿管撕脱）。
我们认为，经尿道硬性输尿管镜是治疗盆腔段输尿管结石以及在体外冲击波碎石（ESWL）失败后的部分骶段或腰段输尿管结石病例的一种有用、安全且有效的技术。经尿道硬性输尿管镜结石清除效果极佳，并发症较少。
