Department of Urology, Ministry of Health, Yozgat State Hospital, Yozgat, Turkey.
Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey.
J Endourol. 2022 Aug;36(8):1013-1017. doi: 10.1089/end.2021.0751. Epub 2022 Mar 24.
To investigate the effect of the diameter of ureteral access sheath (UAS) used during retrograde intrarenal surgery (RIRS) on operative parameters, perioperative ureteral injury, and ureteral stricture development. The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to the diameter of UAS (9.5F/11.5F [Group 1] and 12F/14F [Group 2]) placed during the operation. At the end of the operation, ureteral injury was checked visually using semirigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images were used to observe newly developing ureteral dilatation. There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury, while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury ( = 0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) ( = 0.371). The results of our study showed that the use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase there is no difference in ureteral stricture formation.
为了研究逆行性肾内手术（RIRS）中使用的输尿管鞘（UAS）直径对手术参数、围手术期输尿管损伤和输尿管狭窄发展的影响。该研究设计为前瞻性随机对照试验，共纳入 320 例接受 RIRS 的患者。根据手术中使用的 UAS 直径（9.5F/11.5F[组 1]和 12F/14F[组 2]）将患者分为两组。手术结束时，使用半刚性输尿管镜对输尿管损伤进行目视检查，并根据输尿管损伤量表进行分类。在术后第一年，使用控制 CT 尿路造影图像观察新出现的输尿管扩张。两组患者在患者和结石特征、手术时间、术后结石清除率和术后感染发展参数方面无统计学差异。在组 1 中，30 例（18.8%）患者有低级别输尿管损伤，8 例（5%）患者有高级别输尿管损伤，而在组 2 中，44 例（27.5%）患者有低级别输尿管损伤，19 例（11.9%）患者有高级别输尿管损伤（=0.013）。在术后期间，发现 5 例（1.6%）患者有输尿管狭窄，其中 4 例（2.5%）在组 2，1 例（0.6%）（=0.371）。我们的研究结果表明，对于未预先放置支架的患者，使用 12F/14F UAS 会增加高级别输尿管损伤的风险；然而，尽管这种增加，输尿管狭窄的形成没有差异。
