Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.
J Urol. 2011 Sep;186(3):1035-40. doi: 10.1016/j.juro.2011.04.097. Epub 2011 Jul 23.
We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi.
We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates.
A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate.
Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.
我们评估了影响儿童输尿管结石输尿管镜检查并发症发生率的因素。
我们回顾性评估了 2000 年至 2010 年间在土耳其 16 家中心接受输尿管镜检查的 642 名儿童。使用不同口径的半刚性输尿管镜在 660 次治疗中治疗 670 个输尿管单位。根据 Satava 和 Clavien 分类系统评估并发症。进行单因素和多因素分析以确定影响并发症发生率的预测因素。
共有 367 名女性和 265 名男性接受了研究。患者年龄的平均值±标准差为 90.2±51.4 个月（范围 4 至 204 个月）。平均±标准差结石大小、手术时间和术后住院时间分别为 8.9±4.7mm、45.8±23.8 分钟和 1.8±2.8 天。在平均±标准差随访 13.3±17.6 个月后，92.8%的患者结石清除，疗效指数为 90.3%。并发症发生在 8.4%的患者（642 例中的 54 例）中，术中发生 25 例（Satava 分级 I 至 II 级 22 例），术后早期发生 25 例（Clavien 分级 I 至 II 级 23 例），术后晚期发生 4 例（均为 III 级）。虽然手术时间、年龄、机构经验、口扩张、支架和结石负荷在单因素分析中具有统计学意义，但多因素分析显示手术时间是唯一具有统计学意义的影响并发症发生率的参数。
半刚性输尿管镜检查是一种有效的治疗方法，结石清除率为 90%，疗效指数为 90.3%。大多数并发症为低级别且自限性的。我们的结果证实，手术时间延长是并发症的独立预测因素，在选择和实施治疗方式时应考虑这一因素。
