Mitchell Christopher, Kuebker Joseph, McCormick Benjamin, Marien Tracy, Herrell S Duke, Miller Nicole L
Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
J Endourol. 2017 Jun;31(6):573-576. doi: 10.1089/end.2017.0007. Epub 2017 Apr 4.
During ureteroscopy (URS), ureteral dilation may be required to increase the likelihood of accessing the ureter to complete the procedure. Thus, we sought to assess the safety and efficacy of using Lubriglide sequential ureteral dilators (Boston Scientific) to promote primary URS, without need for prestenting.
Retrospective review was performed of a consecutive series of patients undergoing primary URS by a single surgeon (N.L.M.) from 2011 to 2013. The primary outcomes were to characterize the use, safety, and efficacy of sequential ureteral dilators to promote stone treatment during URS.
A total of 316 nonprestented cases of primary URS were attempted over the study period. Use of sequential ureteral dilators to promote ureteral access was performed in 109 (34.5%) cases and was effective to allow completion of the procedure in 102 (93.6%) cases. No intraoperative complications occurred while performing sequential ureteral dilation. Fourteen patients (4.3%) required ureteral stent placement for passive ureteral dilation, with definitive stone treatment at a later date. Postoperative radiographic follow-up was available for 272 (86.1%) cases, and no ureteral strictures were detected in the ureteral dilation group. On multivariate analysis, both a history of prior extracorporeal shockwave lithotripsy [odds ratio (OR) 0.45, confidence interval (CI) 0.25, 0.81, p = 0.008] and prior URS (OR 0.42, CI 0.25, 0.70, p = 0.001) were inversely associated with need to perform ureteral dilation.
Approximately 1/3 of nonprestented patients may require ureteral dilation for effective completion of primary URS. Use of sequential ureteral dilators may significantly decrease the need for prestenting and a secondary procedure to complete stone treatment. Thus, we conclude that sequential ureteral dilators represent a safe and effective method to perform ureteral dilation to promote ureteral access and allow for effective stone treatment in one setting.
在输尿管镜检查（URS）过程中，可能需要进行输尿管扩张，以增加进入输尿管完成手术的可能性。因此，我们试图评估使用Lubriglide序贯输尿管扩张器（波士顿科学公司）促进原发性URS的安全性和有效性，而无需预先置入支架。
对2011年至2013年由单一外科医生（N.L.M.）进行原发性URS的一系列连续患者进行回顾性研究。主要结局是描述序贯输尿管扩张器在URS期间促进结石治疗的使用情况、安全性和有效性。
在研究期间共尝试了316例未预先置入支架的原发性URS病例。109例（34.5%）使用序贯输尿管扩张器促进输尿管进入，其中102例（93.6%）有效地完成了手术。进行序贯输尿管扩张时未发生术中并发症。14例患者（4.3%）需要置入输尿管支架进行被动输尿管扩张，随后进行确定性结石治疗。272例（86.1%）病例有术后影像学随访，输尿管扩张组未检测到输尿管狭窄。多因素分析显示，既往体外冲击波碎石术史[比值比（OR）0.45，置信区间（CI）0.25，0.81，p = 0.008]和既往URS史（OR 0.42，CI 0.25，0.70，p = 0.001）均与进行输尿管扩张的需求呈负相关。
约1/3未预先置入支架的患者可能需要进行输尿管扩张以有效完成原发性URS。使用序贯输尿管扩张器可显著减少预先置入支架和进行二次手术以完成结石治疗的需求。因此，我们得出结论，序贯输尿管扩张器是一种安全有效的输尿管扩张方法，可促进输尿管进入并在一次手术中实现有效的结石治疗。
