Department of Urology, The Ohio State University Medical Center, Columbus, Ohio.
College of Medicine, The Ohio State University Medical Center, Columbus, Ohio.
J Urol. 2020 Nov;204(5):976-981. doi: 10.1097/JU.0000000000001147. Epub 2020 May 27.
Ureteral access sheaths are commonly used during ureteroscopy to facilitate stone removal, improve visibility and maintain low intrarenal pressures. However, the use of a ureteral access sheath can cause ureteral wall ischemia and ureteral tears, potentially increasing the risk of postoperative ureteral stricture and obstruction. We studied the impact of ureteral access sheath use on postoperative imaging studies. Secondary objectives included studying the impact of other intraoperative parameters on postoperative imaging studies.
A retrospective chart review was conducted of cases that underwent ureteroscopy for nephroureterolithiasis across 2 high volume institutions between January 2012 and September 2016. Patient demographics, cumulative stone size, operative time, use of ureteral access sheath, laser lithotripsy, basket extraction, preoperative ureteral stent and postoperative ureteral stent placement were extracted from the electronic medical record. Findings of followup renal ultrasound, kidney-ureter-bladder x-ray and/or computerized tomography at approximately 8 weeks after surgery were recorded.
A total of 1,332 ureteroscopies were performed with 1,060 cases (79.6%) returning for routine upper tract imaging after ureteroscopy. Postoperative hydronephrosis was noted following 127 cases (12.0%). Factors predicting presence of hydronephrosis after ureteroscopy include lower body mass index (p=0.0016), greater cumulative stone size (p=0.0003), increased operative time (p <0.0001), preoperative ureteral stent (OR 1.49, p=0.0299) and postoperative ureteral stent placement (OR 6.43, p=0.0031). Postoperative hydronephrosis was not associated with use of ureteral access sheath, age, laser lithotripsy or basket extraction.
Use of ureteral access sheath did not have a significant impact on development of postoperative hydronephrosis, suggesting ureteral access sheath is safe for use during ureteroscopy. Ureteral strictures remain rare following ureteroscopy, seen in only 1.0% of our cohort. With an observed prevalence of hydronephrosis of 12.0% on followup imaging at 8 weeks, routine upper tract imaging after ureteroscopy remains a valuable prognostic tool.
输尿管通道鞘常用于输尿管镜检查，以方便结石取出，提高可视性并维持低肾内压。然而，输尿管通道鞘的使用会导致输尿管壁缺血和输尿管撕裂，从而增加术后输尿管狭窄和梗阻的风险。我们研究了输尿管通道鞘使用对术后影像学研究的影响。次要目标包括研究其他术中参数对术后影像学研究的影响。
对 2012 年 1 月至 2016 年 9 月期间在 2 家高容量机构接受输尿管镜检查治疗肾盂输尿管结石的病例进行回顾性图表回顾。从电子病历中提取患者人口统计学资料、结石累计大小、手术时间、输尿管通道鞘、激光碎石术、篮筐提取、术前输尿管支架和术后输尿管支架置入等资料。记录术后 8 周左右的肾超声、肾脏-输尿管-膀胱 X 线和/或计算机断层扫描的随访结果。
共进行了 1332 例输尿管镜检查，其中 1060 例（79.6%）在输尿管镜检查后常规进行上尿路影像学检查。术后发现 127 例（12.0%）存在肾积水。输尿管镜检查后存在肾积水的预测因素包括较低的体重指数（p=0.0016）、更大的结石累计大小（p=0.0003）、手术时间延长（p<0.0001）、术前输尿管支架置入（OR 1.49，p=0.0299）和术后输尿管支架置入（OR 6.43，p=0.0031）。术后肾积水与输尿管通道鞘使用、年龄、激光碎石术或篮筐提取无关。
输尿管通道鞘的使用与术后肾积水的发生无显著相关性，提示输尿管镜检查时使用输尿管通道鞘是安全的。输尿管镜检查后输尿管狭窄仍然很少见，仅在我们的队列中观察到 1.0%。在 8 周时的随访影像学上观察到肾积水的患病率为 12.0%，因此输尿管镜检查后常规进行上尿路影像学检查仍然是一种有价值的预后工具。
