Savić Slaviša, Vukotić Vinka, Lazić Miodrag, Savić Nataša
Vojnosanit Pregl. 2016 Sep;73(9):850-6. doi: 10.2298/VSP150525071S.
BACKGROUND/AIM: Currently, ureterorenoscopic (URS) stone fragmentation and removal is the treatment of choice for managing ureteral stones, especially mid and distal ones and is advocated as initial management of ureteric stones. The aim of this work was to evaluate the symptoms, necessity, potential benefits and adverse effects of ureteral stent placement after uncomplicated ureteroscopic lithotripsy.
This retrospective-prospective study evaluated a total of 125 patients who had underwent ureteroscopic lithotripsy (URSL). The patients were divided into two groups: stented (59 patients) and unstented (controls, 66 patients). The outcomes measured and compared between the two groups included: stone free rate, postoperative patient pain validated by scale, lower urinary tract symptoms (LUTS), the need for unplanned hospital care, stent related complications, and functional recovery in the form return to normal physical activities.
A successful outcome, defined as being stonefree after 12 weeks, was achieved in all 125 (100%) patients. The stone-free rate showed no significant differences between the two groups. LUTS was frequent complaint in the stented group, with statistically significant difference in the domain of frequency/urgency (p = 0.0314). There was a statistically significant difference between the groups in the mean operative time and mean hospitalization time, mean pain visual analog scale (VAS) score and in the use of nonnarcotic analgesic. On the day of the surgery and until postoperative day 3 (POD 3) and postoperative day 5 (POD 5), the pain score was much higher among stented patients than among the controls (p = 0.0001) and non-narcotic analgesic use (p = 0.001) was frequently required in the stented group.
Routine placement of ureteral stent after URSL is not mandatory and may be associated with stent side effects. Uncomplicated URSL is safe without stent placement after the treatment.
背景/目的：目前，输尿管镜碎石取石术（URS）是治疗输尿管结石，尤其是中下段输尿管结石的首选方法，被推荐作为输尿管结石的初始治疗手段。本研究旨在评估单纯输尿管镜碎石术后放置输尿管支架的症状、必要性、潜在益处及不良反应。
本回顾性-前瞻性研究共纳入125例行输尿管镜碎石术（URSL）的患者。患者被分为两组：放置支架组（59例）和未放置支架组（对照组，66例）。两组间测量和比较的结果包括：结石清除率、通过量表验证的术后患者疼痛程度、下尿路症状（LUTS）、非计划住院治疗的需求、支架相关并发症以及恢复正常体力活动形式的功能恢复情况。
所有125例（100%）患者均取得了成功的治疗效果，即12周后结石清除。两组间结石清除率无显著差异。LUTS在放置支架组中是常见的主诉，在尿频/尿急方面存在统计学显著差异（p = 0.0314）。两组在平均手术时间、平均住院时间、平均疼痛视觉模拟量表（VAS）评分以及非麻醉性镇痛药的使用方面存在统计学显著差异。在手术当天至术后第3天（POD 3）和术后第5天（POD 5），放置支架组患者的疼痛评分远高于对照组（p = 0.0001），且放置支架组经常需要使用非麻醉性镇痛药（p = 0.001）。
URSL术后常规放置输尿管支架并非必要，且可能与支架副作用相关。单纯URSL术后不放置支架是安全的。
