Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Actas Urol Esp (Engl Ed). 2021 Nov;45(9):569-575. doi: 10.1016/j.acuroe.2021.06.009. Epub 2021 Oct 22.
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: 8 mm (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 11 mm (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 11 mm 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明确标准。本研究旨在介绍我们采用输尿管软镜治疗该疾病的经验，分析与使用输尿管软镜相关的变量。
回顾性分析 103 例接受逆行输尿管镜检查术（URS）的患者，采用半刚性或软性输尿管镜。上段结石位置：L2-L3。中段结石位置：L4-L5。半刚性URS 为初始治疗方法，当需要完成手术时则转为软性输尿管镜。无残留结石碎片（6 周）定义为手术成功。分析人口统计学、手术、术后即刻变量，以及与结石相关的变量。评估其与使用输尿管软镜的相关性。
平均年龄为 57.2 岁（15.6 岁）；73 例男性（70.9%）。结石大小：8 毫米（范围 4-30；IQR 4.5）。上段结石位置：58 例（56.3%）。既往有双 J 管置入史：44.7%。既往有肾造瘘术史：10.7%。半刚性 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%）。术后留置双 J 管：84.5%。术后即刻并发症：23 例（22.3%）（Clavien-Dindo I-II：91.3%）。术后输尿管狭窄：5.8%。手术成功：88.4%。残留结石碎片：12 例（11.7%）。自发排出：6 例（50%）。单因素分析显示，上段输尿管结石（p=0.001）大于 11 毫米（p=0.02）和软性输尿管镜的使用相关，多因素分析显示，上段结石（OR 3.5；1.5-8.1；p=0.004）是软性输尿管镜使用的预测因素。
在我们的样本中，腔内治疗获得了较高的成功率。大小大于 11 毫米和上段输尿管位置分别在单因素和多因素分析中表现为软性输尿管镜使用的预测因素。
