Mustafa Mahmoud
Department of Urology, Camlica Hayat Hospital, Alemdag Cad. No. 85, Uskuder-Istanbul, Turkey.
Int Urol Nephrol. 2007;39(1):91-4. doi: 10.1007/s11255-005-4976-5.
To prospectively define the role of the double J-stent placement following ureteroscopic stone therapy in providing a pain-free postoperative period for patients with persisting loin pain and documented hydronphrosis.
The study cohort consisted of 27 patients (mean age: 38.59 years; range: 22-60 years) who had undergone ureteroscopic intervention due to ureteral stone. All of the patients reported loin pain which did not respond to medical therapy associated with various degrees of hydronephrosis documented by ultrasound and/or an excretory urogram. The patients were randomized to either a stented (18 patients) or stentless (nine patients) group following semirigid ureteroscopy (7.5/12 Fr) for the treatment of ureteral calculi (pneumatic lithotripsy). The mean diameter of the stones was 7.7 mm (range: 3-13 mm). Intra-operative balloon ureter orifice dilatation was routinely performed. All patients were evaluated between 0 and 6 days postoperative for loin pain and lower urinary tract symptoms.
Nine patients had loin pain in the first few days following the operation and were in need of intramuscular and/or intravenous analgesics. Of these, four were stented patients (4/18; 22.2%) and five were stentless patients (5/9; 55.5%). Lower urinary tract symptoms were not clinically significant and did not affect the quality of life in terms of loin pain, with the exception of one patient in whom the stent had dropped into the bladder.
We believe that stenting in patients with documented hydronephrosis manifesting in persisting renal colic is recommended. As ureteroscopic therapy may aggregate the edema of ureter mucosa, double J-stent placement may play an important role in offering patients a postoperative period free of loin discomfort. However, further prospective trials should be designed to evaluate the criteria for stentless ureterorenoscopy.
前瞻性地确定输尿管镜下结石治疗后放置双J支架管对持续存在腰部疼痛且有肾盂积水记录的患者术后无痛期的作用。
研究队列包括27例因输尿管结石接受输尿管镜干预的患者（平均年龄：38.59岁；范围：22 - 60岁）。所有患者均报告有腰部疼痛，对与超声和/或排泄性尿路造影记录的不同程度肾盂积水相关的药物治疗无反应。在使用半硬性输尿管镜（7.5/12 Fr）治疗输尿管结石（气压弹道碎石术）后，患者被随机分为支架置入组（18例）或无支架组（9例）。结石平均直径为7.7毫米（范围：3 - 13毫米）。术中常规进行球囊输尿管口扩张。所有患者在术后0至6天接受腰部疼痛和下尿路症状评估。
9例患者在术后最初几天出现腰部疼痛，需要肌内和/或静脉注射镇痛药。其中，4例为支架置入患者（4/18；22.2%），5例为无支架患者（5/�；55.5%）。下尿路症状在临床上不显著，除1例患者支架落入膀胱外，对腰部疼痛方面的生活质量无影响。
我们认为，对于有记录显示肾盂积水且持续肾绞痛的患者，建议置入支架。由于输尿管镜治疗可能会加重输尿管黏膜水肿，放置双J支架管可能在为患者提供无腰部不适的术后时期方面发挥重要作用。然而，应设计进一步的前瞻性试验来评估无支架输尿管肾镜检查的标准。
