Lodh Bijit, Singh Kaku Akoijam, Sinam Rajendra Singh
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Urol Ann. 2015 Apr-Jun;7(2):188-92. doi: 10.4103/0974-7796.150477.
The objective of the following study is to assess the effect of steroidal anti-inflammatory agent on the outcome of ureterorenoscopic lithotripsy (URSL) for ureterovesical junction (UVJ) calculus.
This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal.
One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups.
Fisher's exact and independent t-test was used to compare the outcome between the groups where P < 0.05 was considered to be statistically significant.
There was significant statistical difference (P - 0.016) on the endoscopic appearance of the region of ureteric orifice in patients receiving steroidal anti-inflammatory agent compared with control. Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044). It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).
Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. We strongly recommend its use prior to URSL for UVJ calculus, especially for stone size ≥10.24 mm and on CT evidence of prominent soft tissue swelling at the UVJ.
以下研究的目的是评估甾体类抗炎药对输尿管膀胱连接部（UVJ）结石输尿管镜碎石术（URSL）结果的影响。
这是一项在英帕尔地区医学科学研究所泌尿外科进行的前瞻性随机对照研究。
126例因UVJ结石需要进行输尿管镜碎石术的患者被随机分为两组。研究组在手术前10天每天服用一次30毫克的地夫可特片，而对照组未接受此类治疗。记录两组所有患者手术结果的相关参数。
采用Fisher精确检验和独立t检验比较两组结果，P<0.05被认为具有统计学意义。
与对照组相比，接受甾体类抗炎药治疗的患者输尿管口区域的内镜表现存在显著统计学差异（P = 0.016）。研究组与手术相关的严重疼痛和平均手术时间均低于对照组（分别为P = 0.020和0.031）。研究组的再次治疗率低于对照组（4.76%对17.46%），且具有统计学意义（P = 0.044）。发现计算机断层扫描（CT）表现（r = 0.399）和结石大小（r = 0.410）与UVJ区域的内镜检查结果密切相关（P = 0.001）。
输尿管口发炎和/或闭塞是输尿管膀胱连接部结石清除的主要障碍。本研究表明，服用地夫可特片（一种甾体类抗炎药）可显著改善局部麻醉下URSL的结果。我们强烈建议在进行UVJ结石的URSL之前使用该药，特别是对于结石大小≥10.24毫米且CT显示UVJ处有明显软组织肿胀的情况。
