Kurtulus Fatih O, Avcı Egemen, Tandogdu Zafer, Gungor Ruhi, Karaca Sener, Fazlıoglu Adem, Cek Mete
Department of Urology, Taksim Teaching Hospital, Istanbul, Turkey.
Urol Res. 2012 Aug;40(4):365-71. doi: 10.1007/s00240-011-0419-1. Epub 2011 Sep 4.
We investigated whether previous intraureteral manipulations had an effect on the stone-free rates (SFR) after semi-rigid ureteroscopy (URS) with pneumatic lithotripsy. A retrospective review of all patients who were treated for ureteral stones at two different institutions from June 2003 through January 2010 was performed. Data of 161 URS procedures were analyzed. Stone size, location (distal, mid and proximal) and number (single and multiple), patient demographics and previous intraureteral manipulations were recorded. Patients were grouped as having undergone a previous ipsilateral intraureteral manipulation (Group 1) or not (Group 2). Stone location and number, stone clearance and ancillary procedures were compared. There were no significant differences between Group 1 versus Group 2 for age (p > 0.05), gender (p > 0.05), stone site (p > 0.05) and stone size (p > 0.05). Stones with multiple locations were more frequent in Group 1 (18.5%); however, the difference did not reach statistical significance between the two groups. Similarly, the frequency of multiple stones was also higher in Group 1 (29.6%). Stone site, diameter and gender were comparable in both groups. Stone-free rate of all patients was 84.6% after the first intervention. This rate increased to 98.1% after secondary procedures. Univariate analysis revealed that SFR after URS were low in patients who underwent previous intraureteral manipulations (Group 1:55.6% vs. Group 2:89.1%). SFR after the first intervention were related with stone size, location and number. Additionally, multiple logistic regression analysis indicated a relationship between previous intraureteral manipulations and initial stone clearance rates. Spontaneous passage of stone fragments after URS was associated with stone burden, location, number and previous intraureteral manipulations. Further multiple logistic regression analysis showed that only previous intraureteral manipulations were associated with the expulsion of the stones left for passage.
我们研究了既往输尿管内操作是否会对半硬性输尿管镜检查（URS）联合气压弹道碎石术后的无石率（SFR）产生影响。对2003年6月至2010年1月在两家不同机构接受输尿管结石治疗的所有患者进行了回顾性研究。分析了161例URS手术的数据。记录结石大小、位置（远端、中段和近端）和数量（单发和多发）、患者人口统计学信息以及既往输尿管内操作情况。将患者分为曾接受同侧输尿管内操作的组（第1组）和未接受的组（第2组）。比较结石位置和数量、结石清除情况及辅助操作。第1组和第2组在年龄（p>0.05）、性别（p>0.05）、结石部位（p>0.05）和结石大小（p>0.05）方面无显著差异。第1组中多部位结石更为常见（18.5%）；然而，两组之间的差异未达到统计学意义。同样，第1组中多发结石的频率也更高（29.6%）。两组的结石部位、直径和性别具有可比性。首次干预后所有患者的无石率为84.6%。二次手术后该率升至98.1%。单因素分析显示，既往接受输尿管内操作的患者（第1组：55.6%对第2组：89.1%）URS后的SFR较低。首次干预后的SFR与结石大小、位置和数量有关。此外，多因素logistic回归分析表明既往输尿管内操作与初始结石清除率之间存在关联。URS后结石碎片的自然排出与结石负荷、位置、数量及既往输尿管内操作有关。进一步的多因素logistic回归分析表明，只有既往输尿管内操作与残留结石的排出有关。
