Tran Timothy Y, Hernandez Bustos Natalia, Kambadakone Avinash, Eisner Brian, Pareek Gyan
1 Division of Urology, Warren Alpert Medical School of Brown University , Providence, Rhode Island.
2 Department of Urology, Massachusetts General Hospital , Boston, Massachusetts.
J Endourol. 2017 Sep;31(9):829-834. doi: 10.1089/end.2017.0043. Epub 2017 Jul 19.
Immediate ureteroscopic treatment for patients presenting to the emergency room with symptomatic ureterolithiasis is more commonly being utilized. Recent reports demonstrate good efficacy for emergency ureteroscopy (URS); however, preoperative predictors of treatment success have not been described. In this study, we report our multicenter experience with emergency URS and identify predictors of successful treatment. We also describe the Emergency Ureteral Stone Treatment (EUST) score, which integrates these predictors and stratifies patients into those that are likely and unlikely to have successful treatment.
Laboratory and radiographic data for all patients who underwent emergency URS for acute symptomatic ureterolithiasis from 2010 to 2015 were reviewed. Statistical difference among parameters for patients who were stone free (SF) and not SF was assessed with the Student's t-test. Cutoff values for significant predictors were determined using sensitivity and specificity analysis. The EUST score was determined based on the number of cutoffs a patient was below.
Two hundred two of 247 patients (81.8%) were SF. Two complications (ureteral perforation) occurred. Stone size, duration of symptoms before presentation, and serum white blood count at presentation did not affect SF rates. 95.5% of the treatment failures were attributed to a tight ureter preventing stone access. Patients who received alpha blockers before treatment were more likely to be SF (98.0% vs 55.5%, p < 0.01). Periureteral density (PUD) was lower in SF patients (2.8 HU vs 19.6 HU, p < 0.01), whereas the increase in serum creatinine from baseline (ΔCr) was greater in non-SF patients (0.44 mg/dL vs 0.20 mg/dL, p < 0.01). EUST score of 0, 1, and 2 correlated with SF rates of 20.6%, 81.9%, and 99.2%, respectively.
Combined consideration of PUD and ΔCr with the EUST score can assist in selecting optimal candidates for immediate ureteroscopic management. Administration of alpha blockers before surgery may improve success rates by providing preoperative ureteral dilation.
对于因症状性输尿管结石而到急诊室就诊的患者，即刻输尿管镜治疗的应用越来越普遍。近期报告显示急诊输尿管镜检查（URS）疗效良好；然而，尚未描述治疗成功的术前预测因素。在本研究中，我们报告了我们在急诊URS方面的多中心经验，并确定了治疗成功的预测因素。我们还描述了急诊输尿管结石治疗（EUST）评分，该评分整合了这些预测因素，并将患者分为治疗可能成功和不太可能成功的两类。
回顾了2010年至2015年因急性症状性输尿管结石接受急诊URS的所有患者的实验室和影像学数据。使用学生t检验评估结石清除（SF）患者和未清除结石患者参数之间的统计学差异。使用敏感性和特异性分析确定显著预测因素的临界值。EUST评分根据患者低于临界值的数量确定。
247例患者中有202例（81.8%）结石清除。发生了2例并发症（输尿管穿孔）。结石大小、就诊前症状持续时间和就诊时血清白细胞计数不影响结石清除率。95.5%的治疗失败归因于输尿管狭窄妨碍结石取出。治疗前接受α受体阻滞剂的患者结石清除的可能性更大（98.0%对55.5%，p＜0.01）。SF患者的输尿管周围密度（PUD）较低（2.8 HU对19.6 HU，p＜0.01），而非SF患者基线血清肌酐升高（ΔCr）更大（0.44mg/dL对0.20mg/dL，p＜0.01）。EUST评分为0、1和2分别与结石清除率20.6%、81.9%和99.2%相关。
将PUD和ΔCr与EUST评分综合考虑，有助于选择即刻输尿管镜治疗的最佳候选患者。术前给予α受体阻滞剂可通过术前输尿管扩张提高成功率。
