Giulianelli Roberto, Gentile Barbara Cristina, Vincenti Giorgio, Mavilla Luca, Albanesi Luca, Attisani Francesco, Mirabile Gabriella, Pisanti Francesco, Schettini Manlio
Division of Urology, Nuova Villa Claudia, Rome.
Arch Ital Urol Androl. 2014 Jun 30;86(2):118-22. doi: 10.4081/aiua.2014.2.118.
To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments.
We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS) with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%), 86 in the mid (13.06%) and 368 (57.76%) in the distal ureter. In 504 patients (76.5%) ureterohydronephrosis (Grade II-III) was observed. In 57 patients (8.6%), we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1%) had more than one stone in their distal ureter and 96 (14.8%) had a proximal ureteral stone treated in the same surgery as well.
The overall stone-free rate for ureteral stones was 86.1% (567/658). Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients), 84.8% (73/86 patients) and 96.4% (355/368 patients), respectively. One hundred and twenty patients (18.3%) required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74%) and URS plus Retrograde Intra-Renal Surgery (RIRS) in 23 patients (3.54%). The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%), erosions of urothelium leading to significant bleeding in 15 pts (2.27%), severe pain in 4 pts (0.6%), fever in 3 pts (0.45%) and one case of ureteral avulsion (0.15%).
This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the procedure to an absolute minimum whilst maintaining the two quality indicators for the procedure, namely success rate and length of hospitalisation (86.1% and 34 hours).
以我们这样拥有大量患者的中心为例，展示如何使用一套有限的器械进行输尿管结石碎石术。
我们评估了2004年7月至2011年7月在我们中心进行的与使用钬激光进行输尿管镜下输尿管结石碎石术（URS）相关的病历。总体而言，601例患者共进行了658次输尿管结石URS，其中204次针对近端输尿管结石（31%），86次针对中段输尿管结石（13.06%），368次针对远端输尿管结石（57.76%）。504例患者（76.5%）存在输尿管肾积水（II - III级）。57例患者（8.6%）同时进行了双侧手术，但大多数患者为孤立性远端输尿管结石。106例患者（16.1%）远端输尿管有不止一枚结石，96例患者（14.8%）在同一手术中还治疗了近端输尿管结石。
输尿管结石的总体结石清除率为86.1%（567/658）。近端、中段和远端输尿管结石的成功率分别为68.13%（139/204例患者）、84.8%（73/86例患者）和96.4%（355/368例患者）。120例患者（18.3%）在初次URS后需要额外的手术治疗结石，包括97例患者（14.74%）进行第二次URS，23例患者（3.54%）进行URS加逆行肾内手术（RIRS）。第二次治疗后的总体结石清除率为99.3%。术中并发症发生率为5.92%，包括16例患者输尿管穿孔（2.4%）、15例患者尿路上皮糜烂导致严重出血（2.27%）、4例患者严重疼痛（0.6%）、3例患者发热（0.45%）和1例输尿管撕脱（0.15%）。
本研究表明，无论性别、年龄、结石位置或结石大小，使用钬激光碎石术都是治疗输尿管结石的一种安全有效的方法。我们使用的器械极为有限，目的是在保持手术成功率和住院时间这两个质量指标（分别为86.1%和34小时）的同时，将手术相关成本降至绝对最低。
