Geraghty Robert M, Rai Bhavan P, Jones Patrick, Somani Bhaskar K
Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
James Cook University Hospital, Middlesbrough, UK.
Curr Urol Rep. 2017 Feb;18(2):11. doi: 10.1007/s11934-017-0660-4.
Ureteroscopic treatment of urolithiasis has become safer and more effective in the modern era. With a rise in the incidence of bilateral urolithiasis, management dilemma of staged single-side ureteroscopy versus bilateral simultaneous ureteroscopy (BS-URS) is often debatable. This review evaluates the current evidence base for bilateral simultaneous ureteroscopic approach in the modern era.
A systematic review was conducted from 1990 to June 2016 including all English language articles reporting on outcomes of BS-URS for urolithiasis. Data was split into two periods: period 1: 2003-2012 and period 2: 2013-2016, and analysed using SPSS version 21. A total of 11 studies (491 patients) were identified from a literature search of 148 studies with mean age of 45 years and a male: female ratio of 2:1 and a mean operative time of 69 min (SD = ±15). The initial and final stone-free rate (SFR) was 87 and 93%, respectively. Post-operative stents were placed in 89% of patients with a mean hospital stay of 1.6 days (SD = ±0.5). Overall, there was a significant negative association between case volume (procedures per month) and complication rate (p = 0.045). Mean hospital stay was significantly longer in period 1 (1.9 days, SD = ±0.5) than period 2 (1.3 days, SD = ±0.3) and complications were also significantly higher in period 1 (47%) compared to period 2 (12%) (p < 0.001). There were six studies examining holmium laser (HL) lithotripsy and three examining pneumatic lithotripsy (PL). There were significantly more complications after PL than HL; however, their SFR was similar. Our review shows that the complication rates and hospital stay are significantly reduced in the contemporary data suggesting an improving trend in outcomes following BS-URS. Simultaneous bilateral ureteroscopic treatment of urolithiasis is safe and effective in the modern era. Safety is increased in centers with increased number of procedures performed and with laser lithotripsy.
在现代，输尿管镜治疗尿路结石已变得更安全、更有效。随着双侧尿路结石发病率的上升，分期单侧输尿管镜与双侧同时输尿管镜检查（BS-URS）的管理困境常常存在争议。本综述评估了现代双侧同时输尿管镜检查方法的当前证据基础。
对1990年至2016年6月期间的文献进行系统综述，纳入所有报道BS-URS治疗尿路结石结果的英文文章。数据分为两个时期：时期1：2003 - 2012年，时期2：2013 - 2016年，并使用SPSS 21版进行分析。通过对148项研究的文献检索共确定了11项研究（491例患者），平均年龄45岁，男女比例为2:1，平均手术时间69分钟（标准差 = ±15）。初始和最终结石清除率（SFR）分别为87%和93%。89%的患者术后放置了支架，平均住院时间为1.6天（标准差 = ±0.5）。总体而言，病例数量（每月手术例数）与并发症发生率之间存在显著的负相关（p = 0.045）。时期1的平均住院时间（1.9天，标准差 = ±0.5）显著长于时期2（1.3天，标准差 = ±0.3），并且时期1的并发症发生率（47%）也显著高于时期2（12%）（p < 0.001）。有6项研究检查了钬激光（HL）碎石术，3项研究检查了气压弹道碎石术（PL）。PL后的并发症明显多于HL；然而，它们的结石清除率相似。我们的综述表明，当代数据中并发症发生率和住院时间显著降低，表明BS-URS后的治疗效果呈改善趋势。在现代，双侧同时输尿管镜治疗尿路结石是安全有效的。手术例数增加的中心以及采用激光碎石术时安全性会提高。
