Helse Bergen HF, Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.
J Endourol. 2021 Jul;35(7):985-990. doi: 10.1089/end.2020.0421. Epub 2020 Oct 21.
Ureteral stricture is a rare, but serious complication following ureteroscopy (URS) for stones. The aim of this study was to investigate how many patients ended up with a ureteral stricture after URS at our hospital and how these were treated. We also wanted to identify potential risk factors for postendoscopic stricture formation. A retrospective evaluation of 1001 URSs for stone treatment at the day-case surgery unit between 2013 and 2018 was performed. Data on pretreatment status, the surgical procedure, and follow-up were recorded. Exact χ and independent samples -tests were used comparing data among those who developed strictures and those who did not. Multiple logistic regression was performed analyzing risk factors for stricture formation. In total, 1001 URSs were performed in 725 patients, 289 women and 436 men. Of these, 995 cases were eligible for analysis. At follow-up with CT after 3 months, 28 (3.0%) strictures were identified. Of these, 20 received endourologic treatment with balloon dilatation of which 15 (75%) were effective. Definitive treatment in the 13 patients with failed or unattempted endourologic treatment included nephrectomy, reconstructive surgery, permanent nephrostomy, or observation with no further treatment. In multiple regression analysis, use of ureteral access sheath (UAS; odds ratio [OR] 4.6, = 0.011), ureteral perforation (OR 11.8, < 0.0001), and surgical time >60 minutes (OR 5.7, < 0.005) were found to be risk factors for stricture formation. Ureteral stricture is a rare complication of URS. Balloon dilatation should be the first line of treatment. Use of UAS, perforation, and excessive operating time were found to be risk factors for postendoscopic ureteral stricture formation. Special attention to these risk factors should be given to reduce the incidence of ureteral strictures.
输尿管狭窄是输尿管镜检查（URS）治疗结石后罕见但严重的并发症。本研究旨在探讨我院有多少患者在 URS 后出现输尿管狭窄，以及如何治疗这些患者。我们还希望确定内镜后狭窄形成的潜在危险因素。
对 2013 年至 2018 年日间手术单元进行的 1001 例结石治疗 URS 进行回顾性评估。记录术前状态、手术过程和随访数据。对出现和未出现狭窄的患者数据进行确切χ和独立样本 t 检验比较。对狭窄形成的危险因素进行多因素逻辑回归分析。
共对 725 例患者的 1001 例 URS 进行了分析，其中女性 289 例，男性 436 例。在这些患者中，995 例符合分析条件。在 3 个月后的 CT 随访中，发现 28 例（3.0%）狭窄。其中 20 例行腔内治疗，球囊扩张有效 15 例（75%）。13 例腔内治疗失败或未尝试的患者采用肾切除术、重建手术、永久性肾造口术或观察治疗，不进行进一步治疗。多因素回归分析发现，使用输尿管导入鞘（UAS；优势比[OR]4.6， = 0.011）、输尿管穿孔（OR 11.8， < 0.0001）和手术时间>60 分钟（OR 5.7， < 0.005）是狭窄形成的危险因素。
输尿管狭窄是 URS 的罕见并发症。球囊扩张应作为一线治疗方法。UAS 的使用、穿孔和过长的手术时间是内镜后输尿管狭窄形成的危险因素。应特别注意这些危险因素，以降低输尿管狭窄的发生率。
