Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Urology, Boston Medical Center, Boston, Massachusetts, USA.
Can J Urol. 2021 Oct;28(5):10865-10870.
Ureteroscopy and laser lithotripsy is a common treatment option for upper urinary tract calculi. Currently, ureteral stents are placed after uncomplicated ureteroscopy for up to 1 week, but the optimal length of placement is not well defined. Ureteral stents are associated with significant morbidity, particularly stent discomfort. This study aims to determine differences in postoperative unplanned clinic or ED visits based on duration of stent placement.
This is a single-institution, IRB-approved, retrospective cohort study of 559 ureteroscopy cases with laser lithotripsy for urinary tract calculi performed from 2016 to 2018. The primary outcome was unplanned ED or clinic visits within 30 days following surgery and there. The patients were separated into three groups based on stent duration: 1 (0-3 days), 2 (4-6 days), and 3 (> 6 days).
Fifty-eight (10.31%) patients experienced an unplanned visit within 30 days of the procedure. There was no significant difference in unplanned visits among groups for stent duration (p = 0.45). A Clavien grade analysis showed no difference in grades between groups (p = 0.59). A Cox regression model showed no difference in risk of unplanned visit comparing those in groups 2 and 3 to group 1 (p = 0.157 and 0.374, respectively). This also remains to be the case after adjusting for age, sex, and surgeon (p = 0.166 and 0.376, respectively).
We found no difference in unplanned visits in patients based on the duration of stent placement following routine ureteroscopy. Stent removal within 3 days of surgery appears to be sufficient to minimize morbidity after uncomplicated ureteroscopy.
输尿管镜检查和激光碎石术是治疗上尿路结石的常用方法。目前，对于简单的输尿管镜检查后，通常会放置输尿管支架 1 周，但最佳的放置时间尚未明确。输尿管支架会引起明显的发病率，特别是支架不适。本研究旨在根据支架放置时间的不同，确定术后计划外就诊或急诊就诊的差异。
这是一项单中心、IRB 批准的回顾性队列研究，纳入了 2016 年至 2018 年期间接受输尿管镜检查和激光碎石术治疗尿路结石的 559 例患者。主要结局是术后 30 天内计划外的 ED 或门诊就诊。根据支架持续时间将患者分为三组：1 组（0-3 天）、2 组（4-6 天）和 3 组（>6 天）。
58 例（10.31%）患者在术后 30 天内有计划外就诊。支架持续时间不同的三组间，计划外就诊的发生率无显著差异（p=0.45）。Clavien 分级分析显示，各组间的分级无差异（p=0.59）。Cox 回归模型显示，与第 1 组相比，第 2 组和第 3 组发生计划外就诊的风险无差异（p=0.157 和 0.374）。在调整年龄、性别和手术医生后，这一结果仍然成立（p=0.166 和 0.376）。
我们发现，根据常规输尿管镜检查后支架放置时间的不同，患者的计划外就诊无差异。在简单的输尿管镜检查后 3 天内取出支架似乎足以最大限度地减少术后并发症的发生。
