Tsaturyan Arman, Kalogeropoulos George, Lattarulo Marco, Adamou Constantinos, Pagonis Konstantinos, Peteinaris Angelis, Liourdi Despoina, Vrettos Theofanis, Liatsikos Evangelos, Kallidonis Panagiotis
Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
Department of Anesthesiology and ICU, University of Patras, Patras, Greece.
World J Urol. 2022 May;40(5):1217-1222. doi: 10.1007/s00345-022-03949-w. Epub 2022 Feb 12.
To evaluate the effectiveness of ureteroscopic lithotripsy for the management of large proximal ureteral stones > 10 mm using 14/16 Fr ureteral access sheath (UAS).
Patients' data from prospective database undergoing ureteroscopic laser lithotripsy with a use of 14/16Fr UAS were collected. All patients were pre-stented prior to the procedure. The fragmentation was performed with a semi-rigid ureteroscope using holmium laser energy with a power setting of 35 W (frequency-35 Hz; energy-1 J). Follow-up was scheduled at 4 weeks and 3 months postoperatively.
In total 78 patients, 43 males and 35 females, were included in the study. The mean age of the patients was 59.5 ± 13.3 with a mean maximal stone diameter of 13.4 ± 2.1. The mean operative time was 35.7 ± 9.7 and the mean hospital stay was 2 ± 0.7 days. The primary SFR at 4 weeks was 73 patients (93.6%), while all 78 patients (100%) were stone free at 3-month follow-up, 2 of the patients receiving additional treatment. In total, 8 (10.2%) patients experienced Grade II complications. Intraoperative ureteral lesions were observed in 41 (52.6%) cases. Out of them 31 patients (39.7%) developed Grade 1, 8 patients (10.3%) Grade 2 and only 3 patients (2.6%) Grade 3 lesions.
The use of 14/16Fr ureteral access sheath on pre-stented patients was associated with successful outcomes. A high stone-free rate of 93.6% was achieved at 4-week follow-up. The procedure was not associated with increased rate of postoperative complications and intraoperative ureteral injury.
评估使用14/16Fr输尿管通路鞘（UAS）进行输尿管镜碎石术治疗直径>10mm的近端输尿管大结石的有效性。
收集前瞻性数据库中接受使用14/16Fr UAS的输尿管镜激光碎石术的患者数据。所有患者在手术前均预先置入支架。使用功率设置为35W（频率-35Hz；能量-1J）的钬激光，通过半硬性输尿管镜进行碎石。术后4周和3个月安排随访。
本研究共纳入78例患者，其中男性43例，女性35例。患者的平均年龄为59.5±13.3岁，平均结石最大直径为13.4±2.1mm。平均手术时间为35.7±9.7分钟，平均住院时间为2±0.7天。4周时的主要结石清除率（SFR）为73例患者（93.6%），而在3个月随访时所有78例患者（100%）均无结石，其中2例患者接受了额外治疗。共有8例（10.2%）患者发生Ⅱ级并发症。41例（52.6%）病例术中观察到输尿管损伤。其中31例患者（39.7%）发生1级损伤，8例患者（10.3%）发生2级损伤，仅3例患者（2.6%）发生3级损伤。
对预先置入支架的患者使用14/16Fr输尿管通路鞘可取得成功的治疗效果。4周随访时结石清除率高达93.6%。该手术与术后并发症和术中输尿管损伤发生率的增加无关。
