Oğuz Ural, Şahin Tolga, Şenocak Çağrı, Özyuvalı Ekrem, Bozkurt Ömer Faruk, Reşorlu Berkan, Ünsal Ali
Department of Urology, Giresun University School of Medicine, Giresun, Turkey.
Clinic of Urology, Keçiören Training and Research Hospital, Ankara, Turkey.
Turk J Urol. 2017 Sep;43(3):303-308. doi: 10.5152/tud.2017.58997. Epub 2017 Jul 31.
We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS).
A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated.
Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain.
According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.
我们旨在研究逆行性肾内手术(RIRS)术后早期疼痛的相关因素。
对250例因肾结石接受RIRS手术的患者进行前瞻性数据分析。采用视觉模拟评分法(VAS)对所有患者的术后疼痛进行评估。将疼痛严重(VAS评分≥7)的患者分离出来纳入第一组(n = 46)。而无疼痛或疼痛不明显的患者纳入第二组(n = 204)。研究患者相关因素(年龄、性别、肾脏异常、冲击波碎石病史、术前肾积水)、结石相关因素(结石数量、侧别、大小、位置和不透光性)以及手术相关因素(术前和术后输尿管支架置入、输尿管损伤、术后出血和发热、结石清除率、穿刺鞘大小和鞘留置时间)对术后早期疼痛(如有)的影响。
女性使疼痛风险增加3.6倍(p < 0.05)。结石直径每增加1毫米,术后疼痛风险增加1.15倍。鞘留置时间延长是增加疼痛风险的另一个重要因素(p < 0.05)。残留碎片多的患者也容易出现术后早期疼痛。
根据我们的结果,RIRS术后与疼痛相关的患者、结石和手术相关因素为女性、结石大小和鞘留置时间。