Department of Surgery, Division of Urology, McGill University Health Center, McGill University, Montreal Quebec, Canada.
Int Braz J Urol. 2012 Mar-Apr;38(2):195-202; discussion 202-3. doi: 10.1590/s1677-55382012000200007.
Patients with coagulopathy are at increased risk of peri-operative hemorrhage. The aim of the present study was to compare ureteroscopy (URS) in these high risk patients to those with normal bleeding profile.
Twelve patients with coagulopathies (Group I) undergoing 17 URS were included in the study [3 for biopsy of ureteral lesions and 9 for Holmium Laser Lithotripsy (HLL)]. A patient had Child B (MELD 11) cirrhosis, 6 patients were on warfarin, 3 patients on ASA, 1 patient on ASA and clopidogrel, and the last patient was on heparin. URS in Group I was performed without correction of coagulopathy. Group II consisted of 32 patients with normal bleeding profile who underwent 34 URS concurrently.
Group I included 4 ureteral biopsies in 3 patients with suspicious ureteral lesions and 13 URS for HLL in 9 patients with nephrolithiasis. There were no significant differences between the two groups in terms of patient age, sex, percent of renal stones, median operative and fluoroscopy times. When compared with Group II, Group I had significantly larger median stone size (9.2 vs. 14.0 mm, p = 0.01) and significantly lower stone-free rate after fi rst URS (94.1% vs. 69.2%, p=0.04). However, after second URS, stone-free rates were comparable in both groups (92.3% vs. 100 %, p = 0.9). Two (16.7%) patients with coagulopathy were readmitted due to gross hematuria. There were no post-operative complications in Group II.
Although URS in selected patients with coagulopathies is safe, it is associated with significantly lower stone-free rates and higher readmissions due to gross hematuria.
患有凝血障碍的患者在围手术期出血的风险增加。本研究的目的是比较这些高风险患者与正常出血谱患者的输尿管镜检查（URS）。
研究纳入 12 例患有凝血障碍的患者（I 组），共进行了 17 次 URS [3 例为输尿管病变活检，9 例为钬激光碎石术（HLL）]。1 例患者为 B 型 Child 级（MELD 11）肝硬化，6 例患者服用华法林，3 例患者服用阿司匹林，1 例患者服用阿司匹林和氯吡格雷，最后 1 例患者服用肝素。I 组患者未纠正凝血障碍即进行 URS。II 组包括 32 例出血谱正常的患者，同期进行 34 次 URS。
I 组包括 3 例疑似输尿管病变的患者进行 4 次输尿管活检和 9 例肾结石患者进行 13 次 URS 用于 HLL。两组患者的年龄、性别、肾结石百分比、中位手术和透视时间无显著差异。与 II 组相比，I 组的中位结石大小明显更大（9.2 与 14.0mm，p=0.01），首次 URS 后的结石清除率明显更低（94.1%与 69.2%，p=0.04）。然而，在第二次 URS 后，两组的结石清除率相当（92.3%与 100%，p=0.9）。2 例（16.7%）凝血障碍患者因肉眼血尿而再次入院。II 组无术后并发症。
尽管选择性对凝血障碍患者进行 URS 是安全的，但它与结石清除率明显降低和肉眼血尿导致的再入院率较高相关。
