Muslumanoglu Ahmet Y, Fuglsig Sven, Frattini Antonio, Labate Gaston, Nadler Robert B, Martov Alexey, Wong Carson, de la Rosette Jean J M C H
1 Department of Urology, Haseki Training and Research Hospital , Istanbul, Turkey .
2 Department of Urology, University Hospital of Aarhus , Skejby, Aarhus, Denmark .
J Endourol. 2017 May;31(5):446-451. doi: 10.1089/end.2016.0827. Epub 2017 Apr 12.
Double-J stent placement after stone removal by ureteroscopy (URS) is common and recommended in many cases but debatable in others. In this study, the risks and benefits of postoperative Double-J stent placement in URS stone treatment procedures undertaken in current clinical practice are examined.
The Clinical Research Office of Endourological Society (CROES) URS is a prospective, observational, international multicenter study, in which patients are candidates for URS as primary treatment or after failure of prior treatment for ureteral and renal stones. Baseline, intraoperative, and postoperative data were collected. Predictors and outcomes of postoperative stent placement were analyzed by inverse probability-weighted regression adjustment of the relationship between a Double-J stent placement and outcomes (complications, readmission [including retreatment], and length of hospital stay).
Significant predictors of postoperative Double-J stent placement in URS treatment of ureteral stones were intraoperative complications, impacted stones, operation time, stone burden, age, presence of a solitary kidney, and stone-free rate. In renal stone treatment, the predictors identified included operation time, age, preoperative stent placement, anticoagulant use, presence of a solitary kidney, and intraoperative complications. In both ureteral and renal stone treatment groups, postoperative placement of a Double-J stent resulted in significantly fewer postoperative complications (p < 0.001) compared with patients who did not receive a stent.
Patient- and procedure-related variables were identified, which may enable an individualized approach to postoperative stenting, resulting in improved clinical outcomes in urologic stone treatment by URS.
输尿管镜取石术（URS）后放置双J管很常见，在许多情况下都被推荐，但在其他情况下存在争议。本研究探讨了当前临床实践中URS结石治疗术后放置双J管的风险和益处。
内镜泌尿外科学会临床研究办公室（CROES）的URS研究是一项前瞻性、观察性、国际多中心研究，其中患者作为输尿管和肾结石的主要治疗或先前治疗失败后的URS候选者。收集基线、术中及术后数据。通过对双J管放置与结局（并发症、再次入院[包括再次治疗]和住院时间）之间的关系进行逆概率加权回归调整，分析术后放置支架的预测因素和结局。
URS治疗输尿管结石术后放置双J管的显著预测因素为术中并发症、嵌顿结石、手术时间、结石负荷、年龄、单肾情况及结石清除率。在肾结石治疗中，确定的预测因素包括手术时间、年龄、术前放置支架、使用抗凝剂、单肾情况及术中并发症。在输尿管和肾结石治疗组中，与未放置支架的患者相比，术后放置双J管导致的术后并发症显著减少（p < 0.001）。
确定了与患者和手术相关的变量，这可能有助于采用个体化的术后支架置入方法，从而改善URS治疗泌尿系统结石的临床结局。
