1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
2 Case Western Reserve University , School of Medicine, Cleveland, Ohio.
J Endourol. 2018 Aug;32(8):692-697. doi: 10.1089/end.2018.0041. Epub 2018 Apr 26.
Ureteral duplication is the most common ureteral anomaly, occurring in 0.6%-0.7% of the population. Our objective was to compare urolithiasis treatment outcomes in patients with and without ureteral duplication.
Patients with ureteral duplication who underwent ureteroscopy (URS) were identified in a stone registry at a high-volume, tertiary care center from 1998 to 2015. Preoperative, intraoperative, and postoperative data were collected retrospectively. A 1:1 control cohort of patients without duplication was identified, matched by stone location and size, as well as age, body mass index (BMI), and gender. Clinical data and outcomes were compared between duplication and control groups, between partial and complete duplication groups, and between patients in whom duplication was identified intraoperatively vs known preoperatively.
Fifty patients with ureteral duplication who underwent URS were identified and were matched to 50 control patients. Patients with ureteral duplication required longer operative time (55 minutes vs 38.5 minutes, p = 0.022). Ureteral duplication had no effect on stone-free rates or need for additional procedures. High-grade (Clavien 4-5) complications were similar in both groups (4% vs 4%). Location of ureteral duplication and preoperative knowledge of ureteral duplication did not affect operative time or stone-free rates.
Patients with ureteral duplication undergoing URS for urinary stone disease have longer operative times. Preoperative knowledge of ureteral duplication appears to have no significant effect on URS's safety or efficacy. In patients without a prior diagnosis of ureteral duplication, our data suggest that intraoperative detection via endoscopy and fluoroscopy is sufficient to safely and completely treat stone disease.
输尿管重复畸形是最常见的输尿管异常，其发生率约为 0.6%-0.7%。本研究旨在比较输尿管重复畸形患者与非输尿管重复畸形患者的治疗结局。
本研究回顾性分析了 1998 年至 2015 年期间，在一家高容量的三级护理中心的结石登记处接受输尿管镜检查（URS）的输尿管重复畸形患者。收集了患者的术前、术中及术后资料。选择无重复畸形的患者进行 1:1 配对，配对因素包括结石位置和大小，以及年龄、体重指数（BMI）和性别。比较了重复畸形组和对照组、部分重复畸形组和完全重复畸形组、以及术中发现和术前已知重复畸形组患者的临床资料和结局。
共确定了 50 例接受 URS 的输尿管重复畸形患者，并与 50 例对照组患者相匹配。重复畸形组患者的手术时间较长（55 分钟比 38.5 分钟，p=0.022）。重复畸形对结石清除率或需要额外手术无影响。两组的高等级（Clavien 4-5）并发症发生率相似（4%比 4%）。输尿管重复畸形的位置和术前对输尿管重复畸形的了解均不影响手术时间或结石清除率。
输尿管重复畸形患者行 URS 治疗尿石症的手术时间较长。术前对输尿管重复畸形的了解似乎对 URS 的安全性和疗效无显著影响。对于无输尿管重复畸形既往诊断的患者，我们的数据提示通过内镜和透视术中发现可以安全、完全地治疗结石疾病。
