Isen Kenan, Bogatekin Salih, Em Suat, Ergin Huseyin, Kilic Vehbi
Clinic of Urology, State Hospital of Diyarbakir, Ofis cami sok, Ayyildiz Apt., Kat: 5 No:15, 2100, Diyarbakir, Turkey.
Urol Res. 2008 May;36(2):115-9. doi: 10.1007/s00240-008-0135-7. Epub 2008 Apr 2.
We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments > or =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P < 0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (>38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments > or =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.
我们评估了在未进行扩张的情况下，对直径大于1厘米的输尿管下段结石行单纯输尿管镜碎石术（URSL）后常规放置输尿管支架的必要性。共有43例患者因输尿管下段结石大于10毫米接受了URSL。他们被随机分为支架置入组（21例）和无支架组（22例）。使用半硬性输尿管镜和气压弹道碎石机进行URSL，未行输尿管扩张。使用附加钳取石术（AFA）取出直径≥4毫米的结石碎片。评估每组患者的结石清除率、结石大小、手术时间、AFA使用情况、住院时间、术后疼痛、刺激性排尿症状、血尿、再次住院情况及狭窄形成情况。每组的结石清除率均为100%。两组在结石大小、手术时间、AFA使用情况、术后疼痛、血尿及住院时间方面无统计学差异。然而，支架置入组的刺激性排尿症状明显高于无支架组（P < 0.05）。无支架组有1例患者（4.5%）因严重腰痛伴发热（>38℃）需再次住院，而支架置入组有1例患者（4.7%）因近端支架移位需再次住院（P > 0.05）。在3个月的随访排泄性尿路造影（EXU）中，两组均未发现狭窄形成。我们的结果表明，如果使用AFA取出直径≥4毫米的结石碎片，那么在未进行扩张的情况下，对直径大于1厘米的输尿管下段结石行单纯URSL后放置输尿管支架似乎没有必要，从而降低了患者的发病率和再次住院的风险。
