Sharaf Alaa, Amer Tarik, Somani Bhaskar K, Aboumarzouk Omar M
1 Department of Urology, Queen Elizabeth University Hospital , NHS Greater Glasgow and Clyde, Glasgow, United Kingdom .
2 Department of Urology, University Hospital of Southampton NHS Foundation Trust , Southampton, United Kingdom .
J Endourol. 2017 Dec;31(12):1217-1225. doi: 10.1089/end.2017.0253.
Ureteroscopy (URS) is the most common surgical treatment of urolithiasis and can be problematic in patients with a bleeding diathesis. The intent of this review is to systematically review the literature to assess the safety and efficacy of ureteroscopic procedures in these groups of patients.
The systematic review was performed according to the Cochrane diagnostic accuracy review guidelines. The search strategy was conducted to perform a comprehensive database search (1990-2017). A cumulative analysis was done and where applicable a comparative analysis between bleeding diathesis patients and those without.
Eight studies included were all published between 1998 and 2016 with the total number of participants with bleeding diatheses being 1109 with an age range of 18-97. Overall stone-free rate across the studies was 90.8% vs 86.2% in the control group. There was no significant difference in complications between the bleeding diathesis group and control group (N = 12,757, p = 0.07, 95% confidence interval [CI] 0.92, 6.02, I = 78%). Pooled analysis for bleeding-related complications shows a statistically significant difference favoring the control arm (N = 12,757, p ≤ 0.0001, 95% CI 1.81, 5.73, I = 0%). Pooled analysis for thrombosis shows no statistically significant difference between the bleeding diathesis group and the control arm (N = 118, p = 0.67, 95% CI 0.23, 9.86, I = 48%).
The use of URS with or without the holmium laser is a safe and efficient modality for treating patients with urolithiasis who also have a bleeding diathesis or are anticoagulated or on antiplatelet agents. However, this review would suggest that the increased risk of procedure related bleeding is not insignificant and a patient-centered approach should be taken with regards to continuing these agents or not correcting bleeding diatheses.
输尿管镜检查（URS）是治疗尿石症最常用的手术方法，对于有出血倾向的患者可能会出现问题。本综述旨在系统回顾文献，以评估输尿管镜手术在这类患者中的安全性和有效性。
按照Cochrane诊断准确性综述指南进行系统综述。进行检索策略以全面检索数据库（1990 - 2017年）。进行累积分析，并在适用时对有出血倾向的患者与无出血倾向的患者进行对比分析。
纳入的8项研究均发表于1998年至2016年之间，有出血倾向的参与者总数为1109人，年龄范围为18 - 97岁。各研究的总体结石清除率为90.8%，而对照组为86.2%。出血倾向组与对照组之间的并发症无显著差异（N = 12,757，p = 0.07，95%置信区间[CI] 0.92，6.02，I = 78%）。与出血相关并发症的汇总分析显示，有利于对照组的统计学显著差异（N = 12,757，p≤0.0001，95% CI 1.81，5.73，I = 0%）。血栓形成的汇总分析显示，出血倾向组与对照组之间无统计学显著差异（N = 118，p = 0.67，95% CI 0.23，9.86，I = 48%）。
使用有或没有钬激光的URS是治疗同时患有出血倾向、正在接受抗凝治疗或服用抗血小板药物的尿石症患者的一种安全有效的方式。然而，本综述表明，与手术相关的出血风险增加并非微不足道，对于是否继续使用这些药物或不纠正出血倾向，应采取以患者为中心的方法。
