Sanguedolce F, Liatsikos E, Verze P, Hruby S, Breda A, Beatty J D, Knoll T
Department of Urology, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK,
Urolithiasis. 2014 Aug;42(4):329-34. doi: 10.1007/s00240-014-0659-y. Epub 2014 Mar 28.
Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4%). fURS was performed in 72.9% of the respondents' institutions, and 54.2% of the respondents were performing the procedure. For 95% of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9%) and <1 cm (44.2%) and 2 cm (43.8%) in size. The ureteral access sheaths were used routinely by more than 70% of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9% of the surgeons. After fragmentation, 47.2% of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent (p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones (p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities (p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective.
尽管文献中支持使用软性输尿管镜（fURS）治疗肾结石的证据不足，但该方法的应用却日益普遍。通过本研究，我们希望调查fURS在欧洲各国临床实践中治疗肾结石的当前使用情况和适应证。我们通过电子邮件发送了一份包含21个项目的调查问卷进行调查；通过欧洲泌尿外科学会（EAU）会员数据库选择了2894名收件人。问卷通过SurveyMonkey系统收集，数据用SPSS统计软件包进行处理。酌情应用了频率、交叉表和Pearson相关系数。共收集到1168份问卷（回复率40.4%）。72.9%的受访者所在机构开展了fURS，54.2%的受访者进行了该手术。对于95%的使用者而言，fURS被视为一线治疗方法，用于治疗下极结石（45.9%）以及直径<1 cm（44.2%）和2 cm（43.8%）的结石。超过70%的受访者常规使用输尿管通路鞘。45.9%的外科医生常规采用下极结石复位技术。碎石后，47.2%的受访者更倾向于仅取出较大的碎片。在fURS结束时，手术量较低的外科医生更有可能常规放置双J支架（p = 0.001）。手术量较高的外科医生认为光学和数字设备的耐用性更高（p < 0.001），并且与其他治疗方式相比，他们更倾向于认为fURS具有成本效益（p < 0.001）。fURS广泛用于治疗肾结石，其使用情况和适应证可能因年龄和外科医生的病例数量而异。手术量较高的外科医生更倾向于扩展国际指南的适应证，并认为该技术具有成本效益。
