Özsoy M, Acar Ö, Sarica K, Saratlija-Novakovic Z, Fajkovic H, Librenjak D, Esen T, Scheffbuch N, Seitz C
Department of Urology, Vienna General Hospital, Medical University of Vienna, AKH Waehringer Gürtel 18-20, 1090, Vienna, Austria,
World J Urol. 2015 Sep;33(9):1297-302. doi: 10.1007/s00345-014-1435-x. Epub 2014 Nov 12.
To investigate the impact of gender differences on treatment success, intraoperative and postoperative complications in patients undergoing ureteroscopy (URS).
A prospectively maintained database of 927 consecutively performed ureteroscopies on solitary ureteral stones in four different centers was retrospectively analyzed. Stones were detected with preoperative computed tomography scans or intravenous urography imaging. Patients received intravenous antibiotics as perioperative prophylaxis. Patients with symptomatic urinary tract infections (UTI) prior to surgery were excluded. Follow-up was up to 2 weeks after URS or stent removal.
Two hundred and eighty-six women and 641 men were included in this study. Mean stone size was 9 mm (range 2-35 mm). A double-J stent was placed in 240 (83 %) women and 527 (82 %) men at the end of surgery (p = 0.075). There was no significant gender difference in terms of stent dislocation (p = 0.239). Two hundred and fifty-one women (87 %) and 564 men (87 %) were stone-free after the first procedure (p = 0.917). Intraoperative complications were observed in 14 (4.8 %) women and 37 (5.9 %) men (p = 0.313). Severe UTI presenting with fever (>38 °C) and requiring prolonged hospitalization with parenteral antibiotics were observed in 11 (3 %) women and 8 (1 %) men postoperatively. This difference was statistically significant (p = 0.025).
No significant differences between female and male patients harboring ureteral stones with respect to intraoperative complications were detected. Although stone characteristics were comparable between groups, a small number of women had significantly more severe UTI's postoperatively. Our current therapy regimen for URS seems to be efficient and safe both for females and males.
探讨性别差异对输尿管镜检查（URS）患者治疗成功率、术中及术后并发症的影响。
回顾性分析四个不同中心连续进行的927例针对孤立输尿管结石的输尿管镜检查的前瞻性维护数据库。术前通过计算机断层扫描或静脉肾盂造影成像检测结石。患者接受静脉抗生素作为围手术期预防用药。排除术前有症状性尿路感染（UTI）的患者。随访至URS或取出支架后2周。
本研究纳入286名女性和641名男性。平均结石大小为9毫米（范围2 - 35毫米）。手术结束时，240名（83%）女性和527名（82%）男性放置了双J支架（p = 0.075）。在支架移位方面无显著性别差异（p = 0.239）。首次手术后，251名女性（87%）和564名男性（87%）结石清除（p = 0.917）。14名（4.8%）女性和37名（5.9%）男性出现术中并发症（p = 0.313）。术后，11名（3%）女性和8名（1%）男性出现伴有发热（>38°C）且需要静脉使用抗生素延长住院时间的严重UTI。这种差异具有统计学意义（p = 0.025）。
在输尿管结石患者中，未检测到男女患者在术中并发症方面的显著差异。尽管各组结石特征具有可比性，但少数女性术后UTI更为严重。我们目前的URS治疗方案对女性和男性似乎都是有效且安全的。
