一种治疗策略，可帮助选择可能不需要二次干预以去除先前支架置入后有症状的输尿管结石的患者。

A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting.

机构信息

Department of Urology, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.

Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Targu-Mures, Romania.

出版信息

World J Urol. 2020 Nov;38(11):2955-2961. doi: 10.1007/s00345-020-03087-1. Epub 2020 Jan 20.

DOI:10.1007/s00345-020-03087-1

PMID:31960109

Abstract

PURPOSE

This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery.

METHODS

Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage.

RESULTS

34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24 h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p < 0.001), distal stone location (p = 0.046) and stent dwell time (p = 0.02). Predictive factors for spontaneous stone passage after stent removal were smaller size (p < 0.001), distal location (p = 0.001), and stone movement while the stent was indwelling (p = 0.016). A treatment strategy was established that helps select patients suitable for conservative management.

CONCLUSIONS

The majority (61%) of ureteral stones passed spontaneously after pre-stenting; 34% while the stent was indwelling, 27% within 24 h after stent removal. Besides distal stone location, stone size (< 6 mm) and stone movement (≥ 5 cm) while the stent is indwelling indicate patients who are likely to pass their ureteral stone spontaneously after stent removal. The treatment strategy (decision tree) presented here helps identify those patients.

TRIAL REGISTRATION

https://doi.org/10.1186/ISRCTN12112914 .

摘要

目的

本研究旨在评估在计划的二次干预前一天取出输尿管支架是否有助于自发性输尿管结石排出，从而使接受过支架置入术的患者免于接受该手术。

方法

对 2013 年 1 月至 2018 年 1 月期间因症状性输尿管结石接受过支架置入术的 216 例连续病例进行单中心回顾性分析。在局部麻醉下取出留置的支架。告知患者当晚过滤尿液。进行多变量分析以评估自发性结石排出的预测因素。

结果

在支架留置期间，34%（74/216）的患者出现自发性结石排出。在其余 142 例患者中，41%（58/142）在支架取出后 24 小时内出现自发性结石排出。仅 84/216（39%）例患者需要二次干预。对所有 216 例患者的多变量逻辑回归分析显示，自发性结石排出与结石体积较小（p<0.001）、结石位置较低（p=0.046）和支架留置时间（p=0.02）显著相关。支架取出后自发性结石排出的预测因素为结石体积较小（p<0.001）、位置较低（p=0.001）和支架留置期间结石移动（p=0.016）。建立了一种治疗策略，有助于选择适合保守治疗的患者。