Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
World J Urol. 2017 Oct;35(10):1497-1506. doi: 10.1007/s00345-017-2028-2. Epub 2017 Mar 20.
To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.
The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.
Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.
Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.
描述输尿管镜治疗嵌顿性和非嵌顿性输尿管结石的无石率和并发症，并评估嵌顿的预测变量。
临床泌尿科协会研究办公室前瞻性地从全球 114 个中心收集了 1 年的连续数据。符合纳入标准的患者为接受输尿管镜治疗输尿管结石的患者。比较了结石嵌顿患者的特征、治疗细节和结果。采用逻辑回归分析探讨输尿管结石嵌顿的预测变量，并分析嵌顿对结果的影响。
在 8543 例接受治疗的患者中，2650 例（31%）有嵌顿性结石，5893 例（69%）无嵌顿性结石。嵌顿性结石的无石率为 87.1%，低于非嵌顿性结石的 92.7%（p<0.001）。嵌顿性结石术中并发症发生率较高（7.9%比 3.0%，p<0.001）。与非嵌顿性结石组相比，嵌顿性结石组报告的输尿管穿孔和撕脱率明显更高。但未发现结石嵌顿与术后并发症之间存在关联。女性、ASA 评分>1、既往结石治疗、术前尿培养阳性和较大结石是结石嵌顿的预测变量。
与非嵌顿性结石相比，输尿管镜治疗嵌顿性结石的无石率较低，术中并发症发生率较高。结石嵌顿的预测变量可能有助于在诊断过程中识别结石嵌顿。此外，识别结石嵌顿可能有助于选择最佳的治疗方式。
