1 Urology Department, Hadassah Hebrew University Medical Center , Jerusalem, Israel .
2 1st Department of Urology, Aristotle University, G. Gennimatas Hospital , Thessaloniki, Greece .
J Endourol. 2018 Jun;32(6):477-481. doi: 10.1089/end.2018.0050. Epub 2018 Apr 23.
Temporary drainage of the upper urinary tract after ureterorenoscopy for the treatment of urinary stones is almost a routine in endourologic practice. In these cases, a Double-J stent (DJS) is left for 7 or more days. In borderline cases, a ureteral catheter attached to the urethral catheter may be left for 24-48 hours. In some situations, tubeless approach is possible. The purpose of this study was to evaluate the necessity and immediate postoperative implications of upper tract drainage by comparing complications and symptoms at the immediate postoperative period in these three groups of patients.
A database of 516 consecutive patients who underwent ureterorenoscopy for ureteral and/or renal stones between October 2014 and September 2016 was retrospectively evaluated. The cohort was divided according to postoperative drainage type of the upper urinary tract. The data consisted of demographic parameters, stone location, number and burden, severity of preoperative obstruction, and postoperative complications. Symptoms at the immediate postoperative period, assessed by visual analog scale (VAS) score, frequency, and type of analgesics used, were evaluated and compared. Categorical dependent variables were evaluated using chi-square or Spearman's correlation tests, whereas continuous dependent variables were analyzed using Pearson correlation analysis.
There were 196 (38%) tubeless, 214 (41%) UC, and 106 (21%) DJS cases. Patients who were drained with DJS at the end of the procedure were significantly with higher stone volume (p < 0.005), higher stone density (p < 0.005), and with more severe preoperative obstruction (p < 0.005). Postoperative complications (infection, stone-street, and acute renal failure), mean VAS score, or analgesics used were not different in the three subgroups.
A tubeless approach is safe in properly selected cases. There is no difference in postoperative course compared with drained groups. Tubeless procedures may facilitate an outpatient approach for treatment of upper urinary tract stones.
经输尿管镜治疗尿路结石后，几乎常规对上尿路进行暂时性引流。此时，一般留置双 J 管（DJS）7 天以上。在临界病例中，可将连接导尿管的输尿管导管留置 24-48 小时。在某些情况下，也可以采用无管化方法。本研究旨在通过比较三组患者术后即刻并发症和症状，评估上尿路引流的必要性及其对术后即刻的影响。
回顾性分析 2014 年 10 月至 2016 年 9 月期间连续 516 例接受输尿管镜治疗输尿管和/或肾结石患者的数据库。根据术后上尿路引流类型对患者进行分组。数据包括人口统计学参数、结石位置、数量和负荷、术前梗阻严重程度以及术后并发症。通过视觉模拟评分（VAS）评估术后即刻的症状（评分、频率和使用的止痛药类型），并进行比较。采用卡方检验或斯皮尔曼相关检验评估分类变量，采用皮尔逊相关分析评估连续变量。
196 例（38%）患者采用无管化方法，214 例（41%）采用导尿管联合输尿管导管，106 例（21%）采用 DJS。在手术结束时进行 DJS 引流的患者，其结石体积更大（p<0.005）、结石密度更高（p<0.005）、术前梗阻更严重（p<0.005）。三组患者术后并发症（感染、石街形成和急性肾衰竭）、VAS 评分均值或使用的止痛药均无差异。
在适当选择的病例中，无管化方法是安全的。与引流组相比，术后过程无差异。无管化方法可能有利于上尿路结石的门诊治疗。
