Kroczak Tadeusz, Ghiculete Daniela, Sowerby Robert, Ordon Michael, Lee Jason Y, Pace Kenneth T, Honey John R
Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
Can Urol Assoc J. 2018 Aug;12(8):280-283. doi: 10.5489/cuaj.5021. Epub 2018 May 28.
Stone migration during ureteroscopy (URS) for proximal ureteric calculi is a constant challenge. Several retropulsion prevention devices have been developed to optimize URS outcomes. Our technique involves capturing the stone within a four-wire Nitinol stone basket and then performing laser lithotripsy to dust the stone while it is engaged in the basket. The dusted fragments wash out with the irrigation fluid and once small enough, the remaining stone is removed intact.
A retrospective chart review was performed of all proximal semi-rigid URS procedures for a solitary calculus (2000-2016). We compared our new technique introduced in 2010 to URS control procedures that did not use retropulsion prevention techniques or devices.
One hundred and forty patients underwent URS for proximal ureteric calculi. Mean stone diameter was 9.3±3.4 mm, with similar impaction rate between both groups (44.1% vs. 43.1% control; p=n/s). The mean surgical procedure time was 53.3±17.9 minutes for the new technique and 65.2±29.2 minutes for the control group (p=0.005). Compared to the new technique, the control group had a higher rate of retropulsion (33.3% vs. 14.7%; p=0.01) and required flexible URS more often to exclude or remove residual fragments (24.1% vs. 59.1%; p=0.001). Using the new technique, stone-free rates were higher (79.1% vs. 69.4%; p=n/s) and there was a lower likelihood of leaving residual fragments both <3 mm and ≥3 mm (p=0.001).
Our novel technique results in shorter operative times, lower retropulsion rates, and decreases postoperative residual stone fragments.
输尿管镜检查（URS）治疗近端输尿管结石时结石移位一直是个挑战。已研发出多种预防结石后推的装置以优化URS治疗效果。我们的技术是先用四线镍钛合金结石篮捕获结石，然后在结石位于篮内时进行激光碎石将其粉碎成粉末。粉碎后的碎片随冲洗液冲出，当剩余结石足够小时，将其完整取出。
对2000年至2016年期间所有因单个结石行近端半硬性URS手术的病例进行回顾性图表分析。我们将2010年引入的新技术与未使用预防结石后推技术或装置的URS对照手术进行比较。
140例患者接受了近端输尿管结石的URS治疗。结石平均直径为9.3±3.4毫米，两组的嵌顿率相似（新技术组为44.1%，对照组为43.1%；p=无显著差异）。新技术组的平均手术时间为53.3±17.9分钟，对照组为65.2±29.2分钟（p=0.005）。与新技术组相比，对照组的结石后推率更高（33.3%对14.7%；p=0.01），并且更常需要使用软性URS来排除或取出残留碎片（24.1%对59.1%；p=0.001）。使用新技术时，结石清除率更高（79.1%对69.4%；p=无显著差异），残留碎片＜3毫米和≥3毫米的可能性更低（p=0.001）。
我们的新技术可缩短手术时间，降低结石后推率，并减少术后残留结石碎片。
