Dreger Nici Markus, von Rundstedt Friedrich Carl, Roth Stephan, Brandt Alexander Sascha, Degener Stephan
Department of Urology, Helios Medical Center Wuppertal, Helios University Hospital Wuppertal, University of Witten/Herdecke, Heusnerstraße 40, Wuppertal, 42283, Germany.
Scott Department of Urology, Baylor College of Medicine Medical Center, 7200 Cambridge, Houston, TX, USA.
BMC Urol. 2017 Jan 5;17(1):3. doi: 10.1186/s12894-016-0197-8.
Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion.
We retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram.
The study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the "Guidewire-Coil-Technique", the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting.
The "Guidewire-Coil-Technique" is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.
结石回推是输尿管结石体内碎石术面临的一项挑战。其后果是手术时间延长、费用增加以及结石清除率降低。使用额外工具来防止结石向近端移位会带来更多成本以及输尿管损伤风险。我们介绍一种使用常规导丝线圈来防止结石回推的简单技术。
我们回顾性评估了2014年所有患有中近端输尿管结石且接受输尿管镜碎石术（钬激光和/或气压弹道碎石术）治疗的患者。术前结石负荷常规采用低剂量CT扫描（如有）和/或静脉肾盂造影进行评估。
研究人群包括55例患者，共有61枚中近端结石。27例患者采用“导丝线圈技术”接受半硬性输尿管肾镜检查，第二组（n = 28）作为对照组，按常规使用导丝。与对照组相比，意外结石回推发生率有统计学显著降低（2/27 vs. 8/28，p < 0.05），辅助操作的使用也减少（p < 0.05）。手术时间未观察到差异。对照组有1例输尿管损伤需要延长输尿管支架置入时间。
“导丝线圈技术”是一种简单且安全的操作，可能有助于防止近端结石移位，从而提高结石清除率且不会产生额外费用。
