Garvin T J, Clayman R V
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Urol. 1991 Sep;146(3):742-5. doi: 10.1016/s0022-5347(17)37910-7.
Early in our ureteroscopic experience, in an effort to facilitate retrieval of ureteral calculi with the 11.5F and 12.5F rigid ureteroscopes, the distal ureter was routinely balloon dilated to 24F. Among 131 ureteroscopic procedures all consecutive 108 distal ureteral calculi were successfully removed. However, only 65% of 23 upper ureteral calculi were extracted. A followup excretory urogram (6 weeks or later) in 86 patients revealed no distal ureteral strictures. A followup cystogram in 30 patients showed low grade vesicoureteral reflux in 20% of the patients and none of these individuals was symptomatic. As such, balloon dilation of the distal ureter to 24F appears to be well tolerated. Presently, given the advent of smaller ureteroscopes and lithotriptor probes, such extensive ureteral dilation is necessary only in a minority of patients with distal ureteral calculi. In these few patients with calculi resistant to lithotripsy balloon dilation of the ureter to 24F may allow for successful, safe stone extraction, thereby precluding open ureterolithotomy.
在我们开展输尿管镜检查的早期，为了便于使用11.5F和12.5F的硬性输尿管镜取出输尿管结石，通常会将输尿管远端气囊扩张至24F。在131例输尿管镜手术中，连续的108例输尿管远端结石均成功取出。然而，23例输尿管上段结石中仅65%被取出。86例患者的随访排泄性尿路造影（6周或更晚）显示无输尿管远端狭窄。30例患者的随访膀胱造影显示20%的患者有低度膀胱输尿管反流，且这些患者均无症状。因此，将输尿管远端气囊扩张至24F似乎耐受性良好。目前，鉴于更小的输尿管镜和碎石探针的出现，这种广泛的输尿管扩张仅在少数输尿管远端结石患者中是必要的。在这少数对碎石术有抵抗的结石患者中，将输尿管气囊扩张至24F可能允许成功、安全地取出结石，从而避免开放性输尿管取石术。
