Section of Urology, Department of Surgery and Department of Radiology (AS), Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Section of Urology, Department of Surgery and Department of Radiology (AS), Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
J Urol. 2014 Dec;192(6):1710-3. doi: 10.1016/j.juro.2014.06.073. Epub 2014 Jun 27.
Ureteroscopy is central to the surgical management of ureteral stones. Fluoroscopy is conventionally used for intraoperative guidance, although there is growing effort to decrease the exposure of patients and staff to ionizing radiation. We developed a radiation-free approach to ureteroscopy using ultrasound guidance to manage ureteral stones. To our knowledge we present the first randomized trial to study its safety and efficacy.
This single center, randomized clinical trial from 2011 to 2013 enlisted patients who presented with symptomatic ureteral stones 8 mm or less without a significant ipsilateral stone burden. Patients were randomly assigned to ultrasound or fluoroscopic guided ureteroscopy after temporizing ureteral stent placement. Intraoperative ultrasound guidance was performed using real-time imaging with the transducer placed at the patient flank to visualize the collecting system of the ipsilateral kidney. We compared operative time, stone size, stone-free status and complication rates between the 2 groups.
A total of 50 patients were enrolled in study with 25 per arm. There was no difference in stone size (5.9 vs 5.7 mm), patient age (56 vs 52 years) or body mass index (31 vs 30 kg/m(2)) in the test group compared to controls. The ultrasound guidance cohort showed no significant difference in the stone-free rate (86% vs 86%) or the complication rate (8% vs 16%) compared to controls. Operative time was no longer in the ultrasound guidance cohort.
In this feasibility study we found that ureteral stones may be definitively managed in a timely, effective and safe fashion without ionizing radiation in the general population using this novel technique of ultrasound guided ureteroscopy.
输尿管镜检查术是治疗输尿管结石的主要方法。术中常规使用透视引导，但人们越来越希望减少患者和医护人员接受电离辐射的暴露。我们开发了一种无辐射的输尿管镜检查方法，使用超声引导来治疗输尿管结石。据我们所知，这是首次研究该方法安全性和有效性的随机试验。
这项 2011 年至 2013 年进行的单中心、随机临床试验纳入了有症状的、大小为 8mm 或以下且同侧结石负荷无明显增加的输尿管结石患者。患者在临时输尿管支架置入后随机接受超声或透视引导的输尿管镜检查。术中超声引导采用实时成像，将探头放置在患者腰部以可视化同侧肾脏的集合系统。我们比较了两组的手术时间、结石大小、结石清除状态和并发症发生率。
共有 50 例患者入组，每组 25 例。试验组与对照组在结石大小（5.9mm 比 5.7mm）、患者年龄（56 岁比 52 岁）或体重指数（31kg/m² 比 30kg/m²）方面无差异。与对照组相比，超声引导组的结石清除率（86%比 86%）或并发症发生率（8%比 16%）无显著差异。超声引导组的手术时间无明显延长。
在这项可行性研究中，我们发现对于一般人群，使用这种新的超声引导输尿管镜检查技术，可以及时、有效地、安全地治疗输尿管结石，无需电离辐射。
