Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of the Guangzhou Medical University, Kangda Road #1, Haizhou Distritct, Guangzhou, 510230, Guangdong, China.
Guangdong Key Laboratory of Urology, Guangzhou, China.
Urolithiasis. 2018 Aug;46(4):357-361. doi: 10.1007/s00240-017-0990-1. Epub 2017 Jun 12.
The purpose of the study was to present our experience of retaining encrusted ureteral stents (EUS) and discuss the effectiveness of 4.5/6.5F ureteroscope (URS) in the procedure. The data of patients with EUS in our center from January 2012 to December 2016 were retrospectively analyzed. The inclusion criterion was ureteral stents that required intervention above the ureteral orifice to retain and was proved to be encrusted. Impacted stents would be removed by ureteroscope lithotripsy (URL) via 8/9.8F or 4.5/6.5F URS. Percutaneous nephrolithotomy (PCNL) then be the further step if URL failed. 46 cases of EUS were treated in 36 patients from January 2012 to December 2016 in our institution. All subjects consisted of 18 males and 18 females; the average age was 49.81 ± 16.40 years (range 5-86). The mean time from stent insertion to encrustation was 9.28 ± 17.15 months (range 1-120). URL was performed in 44 cases (95.7%), including 19 cases (41.3%) by 8/9.8F URS and 25 cases (54.4%) by 4.5/6.5F URS due to the conventional URS's failure to get into ureteral orifice or further part of ureter. Two patients (4.3%) underwent PCNL due to the inseparable circle developed by the intra-renal segment of encrusted stents. None of the patients underwent extracorporeal shock wave lithotripsy (ESWL) and open surgery. All stents were eventually removed without blood transfusion or ureteral injury, except three cases with post-operative fever. All procedures were performed under one-session anesthesia. URL by 4.5/6.5F ureteroscope might increase the success rate of retaining encrusted ureteral stents remarkably, and then reduce the possibility of PCNL effectively.
本研究旨在介绍我们保留结石嵌顿输尿管支架（EUS）的经验，并探讨 4.5/6.5F 输尿管镜（URS）在该操作中的有效性。回顾性分析 2012 年 1 月至 2016 年 12 月我院 EUS 患者的资料。纳入标准为需要在输尿管口以上干预以保留的输尿管支架，且已证实存在结石嵌顿。通过 8/9.8F 或 4.5/6.5F URS 进行输尿管镜碎石术（URL）可取出嵌顿支架。如果 URL 失败，将进一步行经皮肾镜碎石取石术（PCNL）。2012 年 1 月至 2016 年 12 月，我院共收治 36 例 46 例 EUS 患者，其中男 18 例，女 18 例；平均年龄 49.81±16.40 岁（5-86 岁）。支架置入至结石形成的平均时间为 9.28±17.15 个月（1-120 个月）。44 例（95.7%）患者行 URL 治疗，其中 19 例（41.3%）采用 8/9.8F URS，25 例（54.4%）采用 4.5/6.5F URS，因为常规 URS 无法进入输尿管口或输尿管的进一步部位。由于铸型结石形成的肾内段不可分离，2 例（4.3%）患者改行 PCNL。无患者行体外冲击波碎石术（ESWL）和开放性手术。除 3 例患者术后发热外，所有支架均未输血且无输尿管损伤而最终取出。所有操作均在单次麻醉下进行。采用 4.5/6.5F 输尿管镜行 URL 可显著提高保留结石嵌顿输尿管支架的成功率，从而有效降低改行 PCNL 的可能性。
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