Fuganti Paulo Emilio, Pires Silvio, Branco Renato, Porto José
Hospital Assunção, São Bernardo do Campo, São Paulo, Brazil.
Urology. 2008 Oct;72(4):770-4. doi: 10.1016/j.urology.2008.05.042. Epub 2008 Jul 16.
To evaluate potential preoperative predictive factors for complications in ureteroscopic treatment of ureteral stones.
One thousand two hundred thirty-five semirigid ureteroscopies for ureteral stones were prospectively inserted in our database and analyzed for complications. Preoperative variables evaluated were as follows: age, gender, length of symptoms, previous extracorporeal shock wave lithotripsy (ESWL), associated urinary tract infection (UTI), stone location, and degree of hydronephrosis. Univariate analysis and multivariate logistic regression were conducted.
Fifty-five (4.4%) procedures had complications. There were 8 ureteral perforations, 5 paraureteral stones, 2 ureteral avulsions, 5 mucosal eversions, 1 urethral injury, and 34 mucosal tears. In univariate analysis, age (P = .000), gender (P = .002), previous ESWL (P = .047), stone size (P = .001), and location (P = .001) were predictors of complications. Gender (P = .012), previous in situ ESWL (P = .037), stone size (P = .025), and location (P = .019) remained predictors in multivariate logistic regression.
Semirigid ureteroscopy is a safe procedure with few complications. Larger stones, proximally located (iliac vessels or above) with previous in situ ESWL in men are preoperative predictors for intraoperative complications.
评估输尿管镜治疗输尿管结石术前并发症的潜在预测因素。
前瞻性地将1235例输尿管结石半硬性输尿管镜检查纳入我们的数据库，并分析并发症情况。评估的术前变量如下：年龄、性别、症状持续时间、既往体外冲击波碎石术（ESWL）、合并尿路感染（UTI）、结石位置和肾积水程度。进行单因素分析和多因素逻辑回归分析。
55例（4.4%）手术出现并发症。有8例输尿管穿孔、5例输尿管旁结石、2例输尿管撕脱、5例黏膜外翻、1例尿道损伤和34例黏膜撕裂。单因素分析中，年龄（P = 0.000）、性别（P = 0.002）、既往ESWL（P = 0.047）、结石大小（P = 0.001）和位置（P = 0.001）是并发症的预测因素。多因素逻辑回归分析中，性别（P = 0.012）、既往原位ESWL（P = 0.037）、结石大小（P = 0.025）和位置（P = 0.019）仍是预测因素。
半硬性输尿管镜检查是一种安全的手术，并发症较少。男性中结石较大、位于近端（髂血管或以上）且既往有原位ESWL是术中并发症的术前预测因素。
