Zhang B, Xie H, Liu C
Departamento de Urología, Instituto Tianjin de Urología, The Second Hospital of Tianjin Medical University, Tianjin, China.
Departamento de Urología, Instituto Tianjin de Urología, The Second Hospital of Tianjin Medical University, Tianjin, China.
Actas Urol Esp (Engl Ed). 2019 Dec;43(10):568-572. doi: 10.1016/j.acuro.2019.04.002. Epub 2019 Jul 27.
The study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC).
All patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract.
A total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<.05) were positively associated with upper tract stone formation.
The variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.
本研究旨在确定根治性膀胱切除术后（RC）行尿流改道患者上尿路结石形成的危险因素。
收集2005年1月至2013年12月在本中心接受RC术后尿流改道的所有患者。纳入三种不同的常见尿流改道方式：原位新膀胱（ON：168例患者）、回肠膀胱术（IC：93例患者）或输尿管皮肤造口术（UC：104例患者）。进行单因素和多因素逻辑回归分析以确定上尿路结石形成的独立预测因素。
共纳入365例连续患者（316例男性，49例女性）。中位随访48个月（范围12 - 65个月），36例患者（9.9%）发生上尿路结石。其中，分别有26例（72.2%）、5例（13.9%）和5例（13.9%）患者接受了ON、IC和UC手术。25例患者有肾结石，11例有输尿管结石。所有结石病例均成功进行了微创手术（24例经顺行或逆行途径的内镜激光碎石术、9例经皮肾镜取石术和3例冲击波碎石术）。在单因素和多因素逻辑回归分析中，糖尿病、高血压、尿路感染（UTI）、吻合口狭窄和尿流改道方式（P<0.05）与上尿路结石形成呈正相关。
上尿路结石的可变预测因素可能包括糖尿病、高血压、UTI、吻合口狭窄和尿流改道方式。
