Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Urologie, KMG Klinikum Luckenwalde, Luckenwalde, Germany.
Aktuelle Urol. 2022 Feb;53(1):67-74. doi: 10.1055/a-1378-2495. Epub 2021 Dec 21.
To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones.
This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success.
There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively).
Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.
探讨在接受软性输尿管镜治疗肾结石的患者中，输尿管导入鞘（UAS）插入失败与炎症和其他临床参数之间的关系。
本研究纳入了 2015 年至 2020 年期间在我院接受软性输尿管镜治疗肾结石的患者。排除了同侧输尿管接受任何手术且有自发性结石排出史的患者。根据 UAS 插入成功（组 1）或失败（组 2）将患者分为两组。比较两组的临床特征、术前中性粒细胞、淋巴细胞、单核细胞和血小板计数及其比值，这些都被认为是炎症标志物。采用多变量逻辑回归分析确定影响 UAS 插入成功的独立变量。
组 1 中有 113 例（59.1%）患者，组 2 中有 78 例（40.9%）患者。组 2 中男性、冠心病和术前同侧肾积水的发生率明显较高，而血小板计数和血小板-淋巴细胞比值明显较低。我们的分析显示，UAS 插入失败的四个独立预测因素为：女性（优势比[OR]=2.1）增加了 UAS 插入成功的概率，而肾积水（OR=1.6）、血小板计数低和 PLR 增加了 UAS 插入失败的概率（OR=0.99，OR=0.98）。
我们的结果表明，男性和同侧肾积水与 UAS 插入失败的增加有关。尽管我们发现血小板水平相对较低与 UAS 插入失败之间存在关系，但我们认为需要进一步研究来探讨这个问题。
