Seklehner Stephan, Heißler Ortwin, Engelhardt Paul F, Hruby Stephan, Riedl Claus
a 1 Department of Urology, Landesklinikum Baden-Mödling , Baden, Austria.
b 2 Department of Urology, Paracelsus Medical University Salzburg , Salzburg, Austria.
Scand J Urol. 2016;50(1):56-60. doi: 10.3109/21681805.2015.1079798. Epub 2015 Aug 28.
The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy.
Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses.
In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (< 6 h 4.4%, 6-12 h 3.2%, > 12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28).
Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.
本研究旨在评估泌尿外科医生在进行输尿管镜检查前的工作时长对其安全性和有效性的影响。
对2010年1月至2013年12月在单一机构接受治疗的患者进行分析。该研究评估了患者、结石和手术参数、结石清除率以及在泌尿外科医生工作的三个时长类别下进行的术中并发症：工作时长少于6小时、6 - 12小时和超过12小时。统计分析包括卡方检验、Kruskal - Wallis检验以及单因素和多因素逻辑回归分析。
总共分析了469例输尿管镜检查。术中并发症在相应的时长类别中差异无统计学意义：输尿管穿孔（少于6小时为4.4%，6 - 12小时为3.2%，超过12小时为7%，p = 0.46）和撕脱伤（均为0%）。前12小时内的结石完全清除率为82%，而12小时后为70.2%（p = 0.03）。相应的部分结石清除率分别为4.1%和3.5%（p = 0.83），输尿管镜检查失败率分别为13.8%和26.3%（p = 0.01）。在多因素回归分析中，泌尿外科医生工作12小时后治疗的患者输尿管镜检查失败风险高2.4倍[比值比（OR）= 2.4，95%置信区间（CI）1.2 - 4.7，p = 0.001]，结石完全清除的几率较低（OR = 0.46，95% CI 0.24 - 0.89，p = 0.02）。输尿管穿孔的几率相似（p = 0.28）。
输尿管镜检查前的工作时长不影响其安全性。结石清除率随工作时间增加而降低。工作时间超过12小时被确定为结石清除率受损的独立危险因素。
