Hyams Elias S, Monga Manoj, Pearle Margaret S, Antonelli Jodi A, Semins Michelle J, Assimos Dean G, Lingeman James E, Pais Vernon M, Preminger Glenn M, Lipkin Michael E, Eisner Brian H, Shah Ojas, Sur Roger L, Mufarrij Patrick W, Matlaga Brian R
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Cleveland Clinic Foundation, Cleveland, Ohio.
J Urol. 2015 Jan;193(1):165-9. doi: 10.1016/j.juro.2014.07.002. Epub 2014 Jul 9.
Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.
Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.
Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.
Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.
对于许多肾和输尿管结石患者而言，可弯曲输尿管镜检查正迅速成为一线治疗方法。然而，目前对于孤立性近端输尿管结石患者治疗结果的了解有限。因此，我们开展了一项针对小于2 cm的近端输尿管结石的输尿管镜治疗的前瞻性多机构研究，以更好地明确这种治疗方法相关的临床结果。
前瞻性纳入近端输尿管结石小于2 cm的成年患者。排除伴有同侧肾结石或既往有输尿管支架置入史的患者。进行可弯曲输尿管镜检查、钬激光碎石术及输尿管支架置入。输尿管通路鞘的使用、激光设置以及围手术期和术后管理的其他细节取决于术者个人偏好。术后4至6周通过肾脏超声及肾脏、输尿管和膀胱的X线平片结果确定结石清除情况。
71例患者中，44例（62%）为男性，27例（38%）为女性。平均年龄为48.2岁。美国麻醉医师协会（ASA）分级：1级12例（16%），2级41例（58%），3级16例（23%），4级2例（3%）。平均体重指数为31.8 kg/m²，平均结石大小为7.4 mm（范围5至15 mm），平均手术时间为60.3分钟（范围15至148分钟）。2例患者（2.8%）出现术中并发症，包括轻度输尿管损伤。6例患者（8.7%）出现术后并发症，包括3例尿路感染、2例尿潴留和1例闪发性肺水肿。结石清除率为95%，对于小于1 cm的结石，结石清除率为100%。
对于小于2 cm的近端输尿管结石患者，可弯曲输尿管镜检查具有良好的临床效果且并发症发生率可接受。
