Mishra Amit Kumar, Kumar Santosh, Dorairajan Lalgudi Narayan, Manikandan Ramanitharan, Ramkumar G, Sreerag K S, Mittal Jayesh Kumar
Department of Urology, IKDRC-ITS, Ahmedabad, Gujarat, India.
Department of Urology, JIPMER, Puducherry, India.
Urol Ann. 2020 Jul-Sep;12(3):212-219. doi: 10.4103/UA.UA_95_19. Epub 2020 Jun 10.
The purpose is to study the association of stone, ureteral, and renal morphometric parameters with the relevant outcome variables, i.e., complication rate, stone-free rate (SFR), and operating time of ureterorenoscopic lithotripsy. Although a safe procedure, it still occasionally has major complications. Computed tomography (CT) scan is often performed to diagnose ureteral calculi, providing opportunities for ureteral morphometry that may have a bearing on the outcome of the procedure.
Ureteric, renal, and stone morphometric parameters were measured from CT of the abdomen and pelvis of the 110 patients with ureteral calculi who underwent ureteroscopic lithotripsy (URSL). Data were collected retrospectively in 25 patients and prospectively in 85 patients. Association of these parameters with the outcome variables of the procedure mentioned above was studied.
On univariate analysis, body mass index, stone size, and maximum ureteral wall thickness (MUWT) were found to have a significant association with URSL complications, SFR, and duration of surgery. On multivariable analysis, only MUWT was found to be an independent risk factor for URSL complications. In 90% of total patients with residual stones, MUWT was found to be >4.8 mm.
Ureteral wall thickness of >4.8 mm is associated with prolonged duration of surgery and lower SFR. Patients with ureteral wall thickness of >4.8 mm at the site of ureteral stone who are planned for URSL must be counseled about the higher chances of residual stones and the need for additional procedure.
本研究旨在探讨结石、输尿管及肾脏形态学参数与相关结局变量之间的关联，即输尿管镜碎石术的并发症发生率、结石清除率（SFR）及手术时间。尽管该手术较为安全，但仍偶尔会出现严重并发症。计算机断层扫描（CT）常用于诊断输尿管结石，这为输尿管形态测量提供了机会，而输尿管形态测量可能与手术结局相关。
对110例行输尿管镜碎石术（URSL）的输尿管结石患者的腹部和盆腔CT进行测量，获取输尿管、肾脏及结石的形态学参数。回顾性收集25例患者的数据，前瞻性收集85例患者的数据。研究这些参数与上述手术结局变量之间的关联。
单因素分析显示，体重指数、结石大小及最大输尿管壁厚度（MUWT）与URSL并发症、SFR及手术时长显著相关。多因素分析发现，只有MUWT是URSL并发症的独立危险因素。在所有残留结石患者中，90%的患者MUWT>4.8mm。
输尿管壁厚度>4.8mm与手术时间延长及SFR降低相关。对于计划行URSL且输尿管结石部位输尿管壁厚度>4.8mm的患者，必须告知其残留结石的可能性更高以及可能需要额外的手术。
