Ueki Hideto, Inoue Takaaki, Fujita Masaichiro, Yamamichi Fukashi, Fujisawa Masato
Department of Urology, Kobe University Hospital, Hyogo, Japan.
Department of Urology and Stone Center, Hara Genitourinary Hospital, Hyogo, Japan.
Transl Androl Urol. 2022 Apr;11(4):451-459. doi: 10.21037/tau-21-1043.
Ureteroscopy for middle ureteral stones is often difficult from an anatomical view. This study aimed to evaluate the pelvic anatomy in three dimensions and investigate the relationship between the pelvic anatomy and potential semi-rigid ureteroscopic approach for treating middle ureteral stones.
From a total of 967 patients who underwent ureteroscopy from December 2017 to January 2021, 124 patients who had middle ureteral stones were included in this retrospective cohort study. The pelvic transverse diameter, pelvic vertical diameter, pelvic depth, and lumbosacral angle were measured through preoperative non-contrast computed tomography to define the shape of the pelvic cavity. The relationship between the reachability of the middle ureteral stone using a semi-rigid ureteroscope and the aforementioned anatomical factors, as well as treatment outcomes, was examined retrospectively.
The lumbosacral angle and female sex were significant predictors of the possibility of a semi-rigid ureteroscopic approach to middle ureteral stones [odds ratio =1.08; 95% confidence interval (CI): 1.03-1.14; P=0.003, and odds ratio =3.23; 95% CI: 1.12-9.32; P=0.03, respectively]. The cutoff value of the lumbosacral angle was 149.9°, with a sensitivity of 55.1% and a specificity of 72.7%. The time to reach the stone was longer in the lumbosacral angle <150° group than in the lumbosacral angle ≥150° group (P=0.049).
In this study, gradual lumbosacral angle and female sex are positive predictors of the reachability of the middle ureteral stone with a semi-rigid ureteroscope.
从解剖学角度来看，输尿管镜检查治疗中段输尿管结石往往具有挑战性。本研究旨在对骨盆进行三维解剖评估，并探讨骨盆解剖结构与采用半硬性输尿管镜治疗中段输尿管结石的潜在方法之间的关系。
在2017年12月至2021年1月期间接受输尿管镜检查的967例患者中，本回顾性队列研究纳入了124例患有中段输尿管结石的患者。通过术前非增强计算机断层扫描测量骨盆横径、骨盆垂直径、骨盆深度和腰骶角，以确定盆腔形状。回顾性分析半硬性输尿管镜到达中段输尿管结石的可达性与上述解剖因素以及治疗结果之间的关系。
腰骶角和女性是半硬性输尿管镜治疗中段输尿管结石可能性的重要预测因素[优势比分别为1.08；95%置信区间（CI）：1.03 - 1.14；P = 0.003，以及优势比为3.23；95% CI：1.12 - 9.32；P = 0.03]。腰骶角的截断值为149.9°，敏感性为55.1%，特异性为72.7%。腰骶角<150°组到达结石的时间比腰骶角≥150°组更长（P = 0.049）。
在本研究中，逐渐增大的腰骶角和女性是使用半硬性输尿管镜到达中段输尿管结石的积极预测因素。
