Urotip Diagnosis Center, Istanbul, Turkey.
J Endourol. 2010 Aug;24(8):1263-7. doi: 10.1089/end.2009.0153.
Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed.
Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated.
Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups.
Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.
输尿管镜碎石术后留置输尿管支架有其优点和缺点。在这项随机研究中，评估了在无并发症的输尿管镜下处理嵌顿性输尿管结石时是否需要留置输尿管支架。
2005 年至 2007 年，共有 60 例可评估患者被平均随机分为有支架组和无支架组。所有患者均接受输尿管镜气压弹道碎石术治疗输尿管结石。根据随机分组顺序，完成手术时是否留置支架。术后 3 个月行排泄性尿路造影。所有支架均在术后第 3 周行膀胱镜下取出。评估社会人口统计学和临床变量（年龄、性别、结石位置、结石大小、手术时间、住院时间、麻醉性和非麻醉性镇痛药的使用）以及术后并发症（发热、疼痛延迟出院、急诊就诊、尿潴留、支架相关刺激症状）。
两组患者的平均结石大小无显著差异。支架组的平均手术时间明显延长：30.5±9.6 分钟 vs 43.7±11.6 分钟。在手术当天和术后第 5 天，无支架组使用麻醉性（P=0.004）和非麻醉性镇痛药（P=无显著差异）的频率更高。在术后第 5 天及以后，支架组虽然经常需要使用麻醉性和非麻醉性镇痛药，但无支架组患者几乎不再需要。支架相关刺激症状在支架组中（10% vs 93%）更为严重。无支架组的延迟出院率（23% vs 10%）和计划外急诊就诊率（20% vs 10%）几乎高出两倍。两组的结石清除率均相同（n=29/30；97%）。
在无并发症的输尿管镜碎石术后患者中，常规留置输尿管支架并非必需。根据上述数据，术前可以与患者讨论并同意是否放置支架。
