Ito Katsuhiro, Takahashi Toshifumi, Somiya Shinya, Kanno Toru, Higashi Yoshihito, Yamada Hitoshi
Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.
Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.
Urology. 2021 Aug;154:96-102. doi: 10.1016/j.urology.2021.02.025. Epub 2021 Mar 3.
To evaluate the risk of repeat surgery and stone-related events after flexible ureteroscopy (fURS) for renal stones, and to identify their predictive factors.
This was a single-center, retrospective cohort study of patients (n = 664) who underwent fURS for renal stones with or without concomitant ureteral stones between January 2012 and December 2019. The primary outcomes were time to ipsilateral stone-related surgical intervention and any stone-related event (including ipsilateral renal colic, symptomatic ureteral calculi, obstructive urinary tract infection, and surgical intervention).
During median follow-up of 31.1 months, 103 (15.5%) and 135 (20.3%) patients experienced surgical intervention and any stone-related event, respectively. The estimated 2-year intervention-free survival and stone-event-free survival was 86.9% and 81.6%, respectively. On Cox multivariate analysis, younger age (hazard ratio [HR] 0.96), history of stone surgery (HR 2.17), larger preoperative stone burden (HR 1.03), and larger residual fragment (HR 1.09) showed an association with future intervention. Use of the four identified risk factors (age ≤60, history of stone surgery, stone burden ≥20 mm, and residual fragment ≥4 mm) allowed stratification of patients based on the risk of future intervention (low [score: 0-1], intermediate [2], and high [3-4] risk). The estimated 2-year intervention-free survival rates in low-, intermediate-, and high-risk groups were 96.2%, 86.4%, and 71.3%, respectively.
Patients undergoing fURS are at risk of future ipsilateral surgical intervention and stone-related events. Our simple predictive tool can facilitate treatment decision-making by identifying patients who are at high risk of recurrence.
评估软性输尿管镜检查（fURS）治疗肾结石后再次手术及结石相关事件的风险，并确定其预测因素。
这是一项单中心回顾性队列研究，研究对象为2012年1月至2019年12月期间因肾结石伴或不伴输尿管结石接受fURS治疗的患者（n = 664）。主要结局指标为同侧结石相关手术干预时间及任何结石相关事件（包括同侧肾绞痛、有症状的输尿管结石、梗阻性尿路感染及手术干预）。
在中位随访31.1个月期间，分别有103例（15.5%）和135例（20.3%）患者经历了手术干预及任何结石相关事件。估计的2年无干预生存率和无结石事件生存率分别为86.9%和81.6%。在Cox多因素分析中，年龄较小（风险比[HR] 0.96）、有结石手术史（HR 2.17）、术前结石负荷较大（HR 1.03）及残留碎片较大（HR 1.09）与未来干预相关。使用所确定的4个风险因素（年龄≤60岁、有结石手术史、结石负荷≥20 mm及残留碎片≥4 mm）可根据未来干预风险对患者进行分层（低风险[评分：0 - 1]、中风险[2]及高风险[3 - 4]）。低、中、高风险组估计的2年无干预生存率分别为96.2%、86.4%和71.3%。
接受fURS治疗的患者有未来同侧手术干预及结石相关事件的风险。我们简单的预测工具可通过识别复发高风险患者来促进治疗决策。
