Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department Of Urology, Sourasky Medical Center, Tel-Aviv, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
BMC Urol. 2019 Aug 29;19(1):80. doi: 10.1186/s12894-019-0509-x.
The aim of this study was to examine ureteral stricture rate after the use of UAS in an unstented ureter and compare complications of smaller vs. larger-caliber UAS.
We conducted a retrospective analysis of consecutive RIRS for renal stones, with the use of UAS in unstented ureters. We excluded cases with previous ureteroscopies, who carried ureteral stent or nephrostomy, had impacted stones, underwent radiation treatment, or had urinary tract malignancies. The primary outcome was formation of ureteral strictures diagnosed by hydronephrosis in ultrasound test and late secretion in dynamic renal scan. Secondary outcome was stone-free-rate (SFR) and complications. In addition, we compared safety and efficacy of smaller (9.5/11.5Fr) vs. larger-caliber (12/14Fr) UAS.
The cohort included 165 patients with a median follow-up time of 115 days. There was no case of ureteral stricture formation after the use us UAS, despite using a larger-caliber UAS in nearly half the cases. Larger-caliber UAS was not associated with more complications compared to the smaller-caliber one (p = 0.780). SFR was non-significantly higher in the larger-caliber UAS group (p = 0.056), despite having a larger stone burden, and only stone number was associated with SFR (p = 0.003).
These data suggest that the use of UAS during RIRS in an unstented ureter is safe and does not involve ureteral stricture formation after one procedure. Furthermore, the use of wider sheaths was not found to be associated with higher complications rate.
本研究旨在检查未置支架输尿管中使用 UAS 后的输尿管狭窄率，并比较小口径与大口径 UAS 的并发症。
我们对连续接受 RIRS 治疗肾结石的患者进行了回顾性分析，这些患者的输尿管未置支架。我们排除了既往行输尿管镜检查、携带输尿管支架或肾造口术、结石嵌顿、接受过放射治疗或患有泌尿道恶性肿瘤的患者。主要结局是通过超声检查诊断的肾积水和动态肾扫描中的迟发性分泌而形成的输尿管狭窄。次要结局是无石率（SFR）和并发症。此外，我们比较了小口径（9.5/11.5Fr）与大口径（12/14Fr）UAS 的安全性和疗效。
该队列包括 165 例患者，中位随访时间为 115 天。尽管近一半的病例使用了大口径 UAS，但在使用 UAS 后没有发生输尿管狭窄。与小口径 UAS 相比，大口径 UAS 并未导致更多并发症（p=0.780）。尽管大口径 UAS 组的结石负荷较大，但 SFR 并无显著升高（p=0.056），只有结石数量与 SFR 相关（p=0.003）。
这些数据表明，在未置支架的输尿管中使用 RIRS 时使用 UAS 是安全的，且一次手术后不会发生输尿管狭窄。此外，使用更宽的鞘并未导致更高的并发症发生率。
