Caballero-Romeu Juan-Pablo, Galán-Llopis Juan-Antonio, Pérez-Fentes Daniel, Budia-Alba Alberto, Cepeda-Delgado Marcos, Palmero-Marti Jose-Luis, Cansino-Alcaide Jose-Ramón, Caballero-Pérez Pablo, Ibarluzea-Gonzalez Gaspar
1 University General Hospital of Alicante , Alicante, Spain .
2 University Hospital of Vinalopo , Elche, Spain .
J Endourol. 2016 Nov;30(11):1185-1193. doi: 10.1089/end.2016.0503. Epub 2016 Sep 28.
The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women.
A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded.
Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study.
m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.
本研究旨在评估微通道输尿管镜检查（m-URS）治疗女性远端输尿管结石的有效性、安全性和可重复性。
设计并开展了一项多中心前瞻性观察性研究，研究时间为2015年3月至12月。我们纳入了远端输尿管至少有一颗结石且适合使用MicroPerc 4.85F鞘进行手术治疗的女性患者。排除有临床标准和/或实验室分析表明存在败血症或凝血功能改变的患者。
八家医院共为39名女性实施了手术。各医院患者情况相当一致。仅在年龄、术前支架置入情况和既往尿培养结果方面存在差异。术后即刻结石清除率为88.2%，术后7天为100%。97.4%的患者术后未出现任何并发症，仅1例出现Clavien II级并发症。76.9%的患者输尿管镜术后损伤量表（PULS）未显示任何损伤，20.5%有1级损伤，2.6%有2级损伤。至于各医院间m-URS的可重复性，对结果的统计分析显示参与研究的所有中心之间存在差异。
m-URS是一种有效、安全且可重复的技术，可将对输尿管解剖结构的手术侵袭降至最低。在治疗女性远端输尿管结石方面，获得了与“传统”输尿管镜检查相当且令人满意的结果，不过仍需要进行临床试验。输尿管损伤的减少可能会减少二次手术并提高该手术的成本效益。
