Singh Vishwajeet, Purkait Bimalesh, Sinha Rahul Janak
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Urol Ann. 2016 Oct-Dec;8(4):418-422. doi: 10.4103/0974-7796.192098.
Ureteroscopy is the definitive management for ureteric stone. Conventional ureteroscopy uses fluoroscopy guidance which has radiation exposure to patients as well as hospital staff. Ultrasound is a good radiation-free alternative for using in the urological procedure. With this background, we executed a prospective randomized trial comparing fluoroscopy-guided ureteroscopy versus ultrasound-guided ureteroscopy.
Patients were randomized into two groups (41 into fluoroscopy and 41 into ultrasound group after exclusion) in a single center from July 2014 to March 2015. Semi-rigid ureteroscopy was used in all cases. Ultrasound was used to place guide wire and postprocedure stents placement in ultrasound group. Patient's characteristics; intra- and post-operative parameters were compared between the two groups.
SPSS version 16.0 (Chicago, IL, USA) was used for statistical analysis. The results were presented as percentages and means (± standard deviation). The categorical/dichotomous variables were analyzed using Chi-squared test. Continuous variables were analyzed using unpaired t-test.
A total of 102 adult patients were randomized in this trial and eighty patients undergo the final analysis. Mean stone burden was 41.75 ± 13.44 (17.94-79.20 mm). Mean operative time was 43.90 ± 12.99 (25-82 min) in fluoroscopy group versus 45.61 ± 11.62 (28-78 min) in ultrasound group. The initial success rate was 93.75% (92.30% in fluoroscopy vs. 95.12% in ultrasound group). Overall complications noted in 8.75% and most of the complications were minor in nature.
Ultrasound-guided ureteroscopy is safe and effectively for ureteric stone. Fluoroscopy can be avoided during ureteroscopy for uncomplicated stone. No radiation ureteroscopy is feasible with good success and minimal complication. Larger sample size with multicentric trial needed for its greater applicability.
输尿管镜检查是输尿管结石的确定性治疗方法。传统输尿管镜检查使用荧光透视引导，这会使患者以及医院工作人员受到辐射暴露。超声是泌尿外科手术中一种良好的无辐射替代方法。在此背景下，我们进行了一项前瞻性随机试验，比较荧光透视引导输尿管镜检查与超声引导输尿管镜检查。
2014年7月至2015年3月，在单一中心将患者随机分为两组（排除后，41例进入荧光透视组，41例进入超声组）。所有病例均使用半硬性输尿管镜。超声组使用超声放置导丝和术后支架。比较两组患者的特征、术中和术后参数。
使用SPSS 16.0版（美国伊利诺伊州芝加哥）进行统计分析。结果以百分比和均值（±标准差）表示。分类/二分变量使用卡方检验进行分析。连续变量使用非配对t检验进行分析。
本试验共随机纳入102例成年患者，80例患者接受最终分析。平均结石负荷为41.75±13.44（17.94 - 79.20 mm）。荧光透视组平均手术时间为43.90±12.99（25 - 82分钟），超声组为45.61±11.62（28 - 78分钟）。初始成功率为93.75%（荧光透视组为92.30%，超声组为95.12%）。总体并发症发生率为8.75%，大多数并发症为轻微性质。
超声引导输尿管镜检查治疗输尿管结石安全有效。对于无并发症的结石，输尿管镜检查期间可避免使用荧光透视。无辐射输尿管镜检查可行，成功率高且并发症少。需要更大样本量的多中心试验以提高其适用性。
