Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
J Urol. 2011 Oct;186(4 Suppl):1728-33. doi: 10.1016/j.juro.2011.03.072. Epub 2011 Aug 19.
The use of ureteral access sheaths during ureteroscopy is common but there are sparse data on the safety and outcomes of ureteral access sheath use in children. We compared the outcomes of ureteroscopy with vs without a ureteral access sheath in children.
We retrospectively reviewed all ureteroscopy procedures for urolithiasis in patients younger than 21 years at our hospital from 1999 to 2009. The primary outcome was intraoperative complications. Secondary outcomes were postoperative hydronephrosis, emergency room visit/hospital readmission within 90 days, stone-free status and need for re-treatment. We analyzed associations of a ureteral access sheath with outcomes.
A total of 34 boys and 62 girls with a mean age of 13 years underwent ureteroscopy. A ureteral access sheath was used in 40 of the 96 patients (42%). The mean stone burden was 9.6 mm. Median followup was 11 months (range 0.2 to 110). Intraoperative complication occurred in 7 cases, including perforation/extravasation in 4, a submucosal wire in 2 and stent migration in 1. Intraoperative complications were more common when a sheath was used (15% vs 2%, adjusted OR 8.2, 95% CI 1.3-50.9, p = 0.02). Postoperative hydronephrosis was observed in 7 of 73 cases (10%) but it was not significantly more common when a sheath was used. No ureteral stricture was identified. Sheath use was not associated with postoperative telephone calls, emergency room visits or rehospitalization. Although the stone-free rate tended to be higher in cases without a sheath (78% vs 59%, p = 0.09), this association was not significant in a multivariate model (p = 0.6).
Although intraoperative complications occur more commonly during ureteroscopy with a ureteral access sheath, no increase in longer term adverse effects were observed. Future prospective studies of ureteral access sheath use in children with longer followup are warranted.
输尿管镜检查术中使用输尿管鞘是很常见的，但关于儿童使用输尿管鞘的安全性和结果的数据很少。我们比较了儿童输尿管镜检查术中使用和不使用输尿管鞘的结果。
我们回顾性分析了我院 1999 年至 2009 年期间 21 岁以下患者的所有输尿管镜取石术。主要结果是术中并发症。次要结果是术后肾积水、90 天内急诊就诊/住院再入院、结石清除状态和需要再次治疗。我们分析了输尿管鞘与结果的关系。
34 名男孩和 62 名女孩，平均年龄 13 岁，接受了输尿管镜检查。96 例患者中有 40 例（42%）使用了输尿管鞘。平均结石负荷为 9.6mm。中位随访时间为 11 个月（范围 0.2-110）。术中并发症 7 例，其中穿孔/漏尿 4 例，黏膜下钢丝 2 例，支架移位 1 例。使用鞘时术中并发症更常见（15%比 2%，调整后的 OR 8.2，95%CI 1.3-50.9，p=0.02）。73 例中有 7 例（10%）出现术后肾积水，但使用鞘时并不明显更常见。未发现输尿管狭窄。鞘的使用与术后电话咨询、急诊就诊或再住院无关。虽然无鞘组结石清除率较高（78%比 59%，p=0.09），但在多变量模型中差异无统计学意义（p=0.6）。
虽然在输尿管镜检查术中使用输尿管鞘会增加术中并发症的发生，但在长期随访中未观察到不良反应增加。需要进行前瞻性研究，以观察儿童使用输尿管鞘的效果。
