Sener Tarik Emre, Tanidir Yiloren, Bin Hamri Saeed, Sever Ibrahim Halil, Ozdemir Burcu, Al-Humam Abdulla, Traxer Olivier
a Department of Urology, School of Medicine , Marmara University , Istanbul , Turkey.
b Department of Urology , King Abdulaziz National Guard Hospital , Riyadh , Kingdom of Saudi Arabia.
Scand J Urol. 2018 Jun;52(3):213-218. doi: 10.1080/21681805.2018.1437770. Epub 2018 Feb 20.
This study aimed to investigate the effects of flexible ureteroscopy (F-URS) on renal blood flow using renal Doppler ultrasound (US).
Patients undergoing F-URS were scheduled for Doppler US preoperatively and postoperatively. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were reported. Technical details, operation time, stone characteristics and complications were recorded. Patients were grouped as 9.5/11.5-Flex-X2, 10/12-Flex-X2, 10/12-Flex-XC, 12/14-Flex-X2 and 12/14-Flex-XC, with 28, six, three, seven and two patients in each group, respectively.
Forty-six patients with a mean age of 41.24 years and stone volume of 1685 mm³ were enrolled. The PSV, EDV, PI and RI of renal arteries in all groups in preoperative and postoperative periods were similar. Arcuate artery measurements in all groups were also similar in preoperative and postoperative periods, without any significant difference except in two parameters: RI in the 9.5/11.5-Flex-X2 group and PSV in the 12/14-Flex-X2 group. The resistive index in the arcuate artery of the 9.5/11.5-Flex-X2 group was increased from 0.59 to 0.62 cm/sec postoperatively. The PSV in the arcuate artery of the 12/14-Flex-X2 group was decreased from 30.9 to 27.2 cm/sec. Three patients had urinary tract infections postoperatively and two had sepsis.
This study suggests that compatible ureteroscope-ureteral access sheath combinations with a lumen difference of more than 1.5 Fr can provide safe outcomes in terms of renal blood flow. F-URS can safely be performed in terms of renal perfusion and complication rates with appropriate equipment and instruments.
本研究旨在使用肾多普勒超声（US）研究软性输尿管镜检查（F-URS）对肾血流的影响。
接受F-URS的患者在术前和术后安排进行多普勒超声检查。报告收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）和搏动指数（PI）。记录技术细节、手术时间、结石特征和并发症。患者分为9.5/11.5-Flex-X2、10/12-Flex-X2、10/12-Flex-XC、12/14-Flex-X2和12/14-Flex-XC组，每组分别有28、6、3、7和2例患者。
纳入46例平均年龄41.24岁、结石体积为1685 mm³ 的患者。所有组术前和术后肾动脉的PSV、EDV,、PI和RI相似。所有组术前和术后弓形动脉测量值也相似，除两个参数外无显著差异：9.5/11.5-Flex-X2组的RI和12/14-Flex-X2组的PSV。9.5/11.5-Flex-X2组弓形动脉的阻力指数术后从0.59增加到0.62 cm/秒。12/14-Flex-X2组弓形动脉的PSV从30.9降至27.2 cm/秒。3例患者术后发生尿路感染，2例发生脓毒症。
本研究表明，内腔差异超过1.5 Fr的兼容输尿管镜-输尿管通路鞘组合在肾血流方面可提供安全的结果。使用适当的设备和器械，就肾灌注和并发症发生率而言，F-URS可以安全地进行。
