Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Urology, University Medical Center Mainz, Mainz, Germany; Department of Urology, University of California-San Diego, San Diego, California.
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Urology, University Medical Center Mainz, Mainz, Germany; Department of Urology, University of California-San Diego, San Diego, California.
J Urol. 2015 Aug;194(2):413-7. doi: 10.1016/j.juro.2015.02.2917. Epub 2015 Feb 26.
During ureteroscopy ureteral balloon dilation may be necessary to allow for passage of endoscopic instruments or access sheaths. We assessed the efficacy and complications associated with ureteral balloon dilation.
We retrospectively reviewed the records at 2 institutions from 2000 to 2012 to identify patients who underwent ureteral balloon dilation during ureteroscopic treatment of upper tract stones. An 18Fr balloon dilator was used in all cases. Patients with documented ureteral stricture, radiation therapy or urothelial cancer were excluded from analysis. Primary outcomes were the stone-free rate, operative complications, balloon dilation failure and the postoperative ureteral stricture rate. Complications were divided into intraoperative and postoperative groups according to the Satava and Clavien-Dindo classifications, respectively.
A total of 151 patients fulfilled study criteria. Median followup was 12 months. The stone-free rate was 72% and median time to first postoperative imaging was 2.8 months. Balloon dilation failed in only 8 patients (5%). Eight intraoperative ureteral perforations (5%) were identified, which were managed by a ureteral stent in 7 patients and a percutaneous tube in 1. Endoscopic re-treatment was required in 4 patients with Satava 2b postoperative complications. The postoperative complication rate was 8% (11 cases). A single ureteral stricture was attributable to balloon dilation.
In this contemporary review balloon dilation of the ureter before endoscopic treatment of stone disease was associated with a high success rate and few complications. Ureteral balloon dilation may decrease the need for a secondary procedure in patients undergoing ureteroscopy to manage proximal ureteral and intrarenal stones.
在输尿管镜检查中，可能需要进行输尿管球囊扩张，以允许内镜器械或进入鞘通过。我们评估了输尿管球囊扩张相关的疗效和并发症。
我们回顾了 2000 年至 2012 年 2 家机构的记录，以确定在输尿管镜治疗上尿路结石期间接受输尿管球囊扩张的患者。所有病例均使用 18Fr 球囊扩张器。排除有记录的输尿管狭窄、放射治疗或尿路上皮癌的患者进行分析。主要结局是无石率、手术并发症、球囊扩张失败和术后输尿管狭窄率。根据 Satava 和 Clavien-Dindo 分类，将并发症分别分为术中组和术后组。
共有 151 名患者符合研究标准。中位随访时间为 12 个月。无石率为 72%，首次术后影像学检查的中位时间为 2.8 个月。仅有 8 名患者（5%）发生球囊扩张失败。术中发现 8 例输尿管穿孔（5%），7 例患者采用输尿管支架，1 例患者采用经皮管处理。4 例术后并发症为 Satava 2b 的患者需要内镜再治疗。术后并发症发生率为 8%（11 例）。1 例输尿管狭窄归因于球囊扩张。
在本项当代回顾性研究中，在经内镜治疗结石病前进行输尿管球囊扩张与较高的成功率和较少的并发症相关。在接受输尿管镜治疗近端输尿管和肾内结石的患者中，输尿管球囊扩张可能减少二次手术的需求。
