Natal Alvarez F, Martín Martín S, Torrecilla García-Ripoll J R, Díaz Romero J M, Calleja Escudero J, Bedate Núñez M, Soto Rodríguez J L, Lara Pérez F M, Ruano Mayo A, Zamora Horcajada A, Cuéllar Martín L A, Muñoz Moreno M F, Cortiñas González J R
Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Actas Urol Esp (Engl Ed). 2021 Jul 31. doi: 10.1016/j.acuro.2021.06.003.
Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope.
Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated.
Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis.
Endourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
目前，对于输尿管上段结石的治疗尚无既定标准。本研究的目的是展示我们在该疾病腔内治疗方面的结果，分析与使用软性输尿管肾镜相关的变量。
回顾性分析103例行逆行输尿管镜检查（URS）的患者，使用半硬性或软性输尿管肾镜。近端位置：L2 - L3。中段位置：L4 - L5。初始治疗采用半硬性URS，必要时转为软性URS以完成手术。成功定义为无残留碎片（术后6周）。分析患者的人口统计学、手术、术后即刻变量以及与结石相关的变量。评估它们与使用软性输尿管肾镜的相关性。
平均年龄：57.2岁（标准差15.6）；男性73例（70.9%）。结石大小：8mm（范围4 - 30；四分位间距4.5）。近端位置：58例（56.3%）。既往放置双J管：44.7%。既往肾造瘘：10.7%。半硬性URS转为软性URS：51例（49.5%）。嵌顿性结石：28.2%。术中并发症：2例（1.9%）。术后放置双J管：84.5%。术后即刻并发症：23例（22.3%）（Clavien - Dindo I - II级：91.3%）。术后输尿管狭窄：5.8%。成功率：88.4%。残留碎片：12例（11.7%）。自行排出：6例（50%）。单因素分析显示，软性URS在处理直径大于11mm（P = 0.02）的近端输尿管结石时表现更佳（P = 0.001）；多因素分析显示，在近端结石中[比值比3.5；1.5 - 8.1；P = 0.004]软性URS更具优势。
在我们的样本中，腔内治疗取得了较高的成功率。在单因素和多因素分析中，结石直径大于11mm和输尿管近端位置分别是使用软性输尿管肾镜的预测因素。
