Göktaş Cemal, Horuz Rahim, Akça Oktay, Cetinel Ali Cihangir, Albayrak Selami, Sarıca Kemal
Urology Clinic, Kartal Training Hospital, Istanbul, Turkey.
Urol Res. 2012 Aug;40(4):383-7. doi: 10.1007/s00240-011-0431-5. Epub 2011 Oct 18.
We aimed to evaluate the success rates, auxiliary procedures and complications after ureteroscopic lithotripsy (URS) during which the fragments left in situ for spontaneous passage after complete disintegration into a acceptable (<4 mm) size. 238 patients with ureteral stones were treated with URS between 2005 and 2011, and disintegrated fragments (<4 mm) were left in situ for spontaneous passage. Patients were followed with radiography for 3 months and evaluated with respect to the success rates (stone-free), auxiliary procedures, complication rates and additional analgesic requirement. The median age was 42.2 ± 13.7 years, and overall stone size was 8.79 ± 2.94 mm. Significantly lower rate of stone-free status was achieved in proximal stones (p < 0.05). A second URS was necessary in 5% (n = 12) of the patients. Double-J catheter placement during initial URS did not cause any change in the rate of secondary URS (p = 0.620). Additional oral or intramuscular analgesia was required in 41% (n = 97) and 25% (n = 59) of the patients, respectively, after discharge. The overall stone-free rate was 95% and mean time to complete clearance was 5 days. Severe colic pain within 24 h was noted in 21 (9%), and transient hydro-ureteronephrosis in 31 (13%) patients, as minor complications. Leaving the fragments (<4 mm) in place for spontaneous passage following a successful disintegration in URS could be a reasonable approach with acceptable and comparable stone-free rates, and this approach appears to give chance of shortening the duration of operation and also avoiding from the potential morbidity of repeated manipulations during the both further disintegration and extraction.
我们旨在评估输尿管镜碎石术（URS）后结石清除成功率、辅助操作及并发症情况，在此手术过程中，结石完全碎裂至可接受尺寸（<4 mm）后，将碎片留置原位使其自行排出。2005年至2011年间，238例输尿管结石患者接受了URS治疗，结石碎裂后将<4 mm的碎片留置原位使其自行排出。对患者进行3个月的X线随访，并评估结石清除成功率（结石清除）、辅助操作、并发症发生率及额外镇痛需求。患者中位年龄为42.2±13.7岁，结石总体大小为8.79±2.94 mm。近端结石的结石清除率显著较低（p<0.05）。5%（n = 12）的患者需要再次进行URS。初次URS期间放置双J管并未使二次URS的发生率发生任何变化（p = 0.620）。分别有41%（n = 97）和25%（n = 59）的患者出院后需要额外口服或肌内注射镇痛药物。总体结石清除率为95%，完全清除的平均时间为5天。作为轻微并发症，21例（9%）患者在24小时内出现严重绞痛，31例（13%）患者出现短暂性肾盂输尿管积水。在URS成功碎石后将<4 mm的碎片留置原位使其自行排出，可能是一种合理的方法，其结石清除率可接受且具有可比性，这种方法似乎有机会缩短手术时间，并避免在进一步碎石和取石过程中重复操作带来的潜在发病率。
