Inoue Takaaki, Hamamoto Shuzo, Okada Shinsuke, Yamamichi Fukashi, Fujita Masaichiro, Tominaga Koki, Fujisawa Masato
Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Japan.
Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe City, Japan.
J Endourol. 2022 Feb;36(2):169-175. doi: 10.1089/end.2021.0515.
This retrospective cohort study aimed to evaluate the safety of stentless flexible ureteroscopy (fURS) using a ureteral access sheath (UAS) for stone management. A total of 270 ureteral stentless postoperative patients were analyzed. Stentless indication was characterized by having no ureteral wall or mucosa injury with only slight erosion, <1 hour operative time, and no endoscopic stone fragments with or without stone dust. Postoperative complications and pain were analyzed for safety measurements. In addition, preoperative and intraoperative risk factors associated with the incidence of systemic inflammatory response syndrome (SIRS) and postoperative pain were evaluated. The most common UAS sizes were 10/12F (69.6%) and 9.5/11.5F (28.1%). The rate of patients who were stone free was 95.9%. The median operation time was 34 minutes. Only three grade 1 ureteral injuries occurred intraoperatively. Postoperative SIRS occurred in 8.8% of patients, and postoperative use of analgesics was 35.9%. Only four patients were required to undergo eventual ureteral stenting. Less than 10/12F UAS was the only factor positively associated with preventing postoperative SIRS (odds ratio [OR], 4.733; 95% confidence interval [CI], 1.085-20.644). Older age and preoperative ureteral stenting were positively associated with preventing postoperative pain (OR, 0.970; 95% CI, 0.951-0.990 and OR, 0.427; 95% CI, 0.232-0.786; respectively). Stentless fURS with UAS in stone management was feasible for selected patients. UAS size of <10/12F, older age, and preoperative stenting are possible keystones to achieving stentless fURS with UAS postoperatively. IRB approval number; 20216101.
这项回顾性队列研究旨在评估使用输尿管通路鞘（UAS）的无支架软性输尿管镜检查（fURS）在结石治疗中的安全性。共分析了270例无输尿管支架术后患者。无支架指征的特点是无输尿管壁或黏膜损伤，仅有轻微糜烂，手术时间<1小时，有无结石粉尘但无内镜下结石碎片。分析术后并发症和疼痛以进行安全性测量。此外，评估了与全身炎症反应综合征（SIRS）发生率和术后疼痛相关的术前和术中危险因素。最常用的UAS尺寸为10/12F（69.6%）和9.5/11.5F（28.1%）。结石清除率为95.9%。中位手术时间为34分钟。术中仅发生3例1级输尿管损伤。8.8%的患者术后发生SIRS，术后使用镇痛药的比例为35.9%。仅4例患者最终需要进行输尿管支架置入。小于10/12F的UAS是预防术后SIRS的唯一正相关因素（比值比[OR]，4.733；95%置信区间[CI]，1.085 - 20.644）。年龄较大和术前输尿管支架置入与预防术后疼痛呈正相关（OR分别为0.970；95% CI，0.951 - 0.990和OR，0.427；95% CI，0.232 - 0.786）。在结石治疗中，使用UAS的无支架fURS对选定患者是可行的。小于10/12F的UAS尺寸、年龄较大和术前支架置入可能是术后实现使用UAS的无支架fURS的关键因素。机构审查委员会批准号：20216101。
