Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
Department of Urology, Gyotoku General Hospital, Chiba, Japan.
BJU Int. 2019 Aug;124(2):314-320. doi: 10.1111/bju.14622. Epub 2018 Dec 17.
To evaluate the impact of ureteric stent removal by string vs ureteric stent removal by cystoscope with regard to pain at ureteric stent removal, complications and quality of life, as well as patients' self-rated symptoms, after ureteroscopy (URS) for urolithiasis.
Of 328 patients who underwent URS for upper urinary tract stones at our institution, 149 were randomly divided into a ureteric stent removal by string group (string group) and a ureteric stent removal by flexible cystoscope group (cystoscope group), using gender as a stratification factor. We focused on four sites, namely, the upper abdomen, bladder, flank and urethra, to evaluate the most painful site at stent removal. The primary endpoint was total pain scores for four sites at stent removal in the string group vs the cystoscope group. Secondary endpoints included comparison of the psychological well-being scores of patients using the five-item World Health Organization well-being index (WHO-5) preoperatively, pre-stent removal and 2 weeks after stent removal between the string group and cystoscope group.
Of 149 patients analysed, 74 were in the string group and 75 were in the cystoscope group. In most patients, the ureteric stent was removed ~10 days after URS. The string group experienced significantly less pain than the cystoscope group (mean visual analogue scale [VAS] scores 2.73 vs 5.67; P < 0.001). Although VAS scores for women were not significantly different between the groups (P = 0.300), those for men were significantly lower in the string group (P < 0.001). In particular, men in the string group experienced significantly less urethral pain than those in the cystoscope group. The WHO-5 scores were not significantly different between the groups preoperatively, pre-stent removal or 2 weeks after stent removal. Stent string-related complications and self-rated symptoms were also not significantly different.
Ureteric stent removal by string after URS led to significantly less pain than removal by cystoscope in men. Patients in the string group experienced no more complications in terms of urinary tract infections or accidental dislodgement than those in the cytoscope group.
评估在输尿管镜检查术后通过线绳或输尿管镜取出输尿管支架管对疼痛、并发症和生活质量的影响，以及患者自我报告的症状，这些患者患有上尿路结石。
在我院接受输尿管镜检查治疗上尿路结石的 328 例患者中，149 例患者被随机分为通过线绳取出输尿管支架管组（线绳组）和通过软性输尿管镜取出输尿管支架管组（输尿管镜组），并按性别进行分层。我们重点评估 4 个部位（上腹部、膀胱、腰部和尿道）在支架取出时最疼痛的部位。主要终点是线绳组与输尿管镜组在支架取出时 4 个部位的总疼痛评分。次要终点包括比较线绳组与输尿管镜组患者在术前、支架取出前和取出后 2 周使用 5 项世界卫生组织幸福感指数（WHO-5）的心理幸福感评分。
在 149 例患者中，74 例患者进入线绳组，75 例患者进入输尿管镜组。大多数患者在输尿管镜检查术后 10 天左右取出输尿管支架管。与输尿管镜组相比，线绳组疼痛明显较轻（平均视觉模拟评分 2.73 分比 5.67 分；P < 0.001）。虽然两组女性患者的 VAS 评分无显著差异（P = 0.300），但男性患者的 VAS 评分在线绳组明显较低（P < 0.001）。特别是，线绳组的男性患者尿道疼痛明显较轻。两组患者术前、支架取出前和取出后 2 周的 WHO-5 评分无显著差异。两组支架线绳相关并发症和自我报告症状也无显著差异。
与输尿管镜取出相比，男性患者在输尿管镜检查术后通过线绳取出输尿管支架管疼痛明显较轻。与输尿管镜组相比，线绳组患者在尿路感染或意外移位方面并未发生更多并发症。
