Department of Urology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
J Endourol. 2010 Oct;24(10):1589-92. doi: 10.1089/end.2010.0145.
The use of flexible ureteroscopy (URS) for nephrolithiasis has been rapidly expanding. Initially, safety guidewires were maintained alongside the ureteroscope during stone manipulation to prevent loss of access and allow stent insertion in the event of perforation. We intend to determine the safety of flexible URS without a separate safety guidewire in a large series of patients.
A retrospective chart review was performed on all cases of flexible URS with laser lithotripsy performed by a single surgeon from August 2003 to May 2008. Preoperative patient characteristics, radiographic stone sizes, operative findings, and postoperative outcomes were recorded. Patients with renal or ureteropelvic junction (UPJ) stones were isolated for a qualitative data analysis.
Flexible URS was performed on 305 kidneys in 246 consecutive patients, of which 59 cases were bilateral. Cases were subdivided into complicated and uncomplicated. Two hundred seventy cases were uncomplicated and performed without a safety guidewire. No intraoperative complications resulted from the lack of a safety guidewire, including no cases of lost access, ureteral perforation/avulsion, or need for percutaneous nephrostomy tube. Thirty-five cases were complicated, necessitating a safety guidewire. Of these, 16 had concomitant obstructing ureteral stones, 5 had encrusted ureteral stents, and 14 had difficult access because of large stone burden or aberrant anatomy.
This study demonstrates that, in a large series of patients, a safety guidewire was not necessary for routine cases of flexible URS with laser lithotripsy on renal or UPJ stones. Particular cases with complicated anatomy, difficult access, concomitant ureteral stones, simultaneous stone basketing, or bulky stone burden still necessitate use of a safety guidewire because of increased risk of adverse outcomes.
经输尿管软镜(URS)治疗肾结石的应用迅速扩大。最初,安全导丝与输尿管镜一起用于结石操作,以防止通道丢失,并在发生穿孔时允许插入支架。我们旨在确定在没有单独安全导丝的情况下,在大量患者中使用柔性 URS 的安全性。
对 2003 年 8 月至 2008 年 5 月期间,由一名外科医生进行的所有激光碎石术软性输尿管镜检查的病例进行了回顾性图表审查。记录了术前患者特征、影像学结石大小、手术发现和术后结果。将肾结石或肾盂输尿管连接部(UPJ)结石患者分离出来进行定性数据分析。
在 246 例连续患者的 305 个肾脏中进行了柔性 URS,其中 59 例为双侧。病例分为复杂和非复杂。270 例为非复杂病例,未使用安全导丝。由于缺乏安全导丝,没有发生术中并发症,包括没有丢失通道、输尿管穿孔/撕脱或需要经皮肾造口管的情况。35 例为复杂病例,需要使用安全导丝。其中,16 例合并有梗阻性输尿管结石,5 例有结石附着的输尿管支架,14 例由于结石负荷大或异常解剖结构而导致难以进入。
本研究表明,在大量患者中,对于肾结石或 UPJ 结石的激光碎石术常规软性 URS,安全导丝不是必需的。特定的解剖结构复杂、进入困难、合并输尿管结石、同时进行结石篮取或结石负荷大的病例仍需要使用安全导丝,因为不良结果的风险增加。