Department of Urology, Northwest Permanente, Portland, Oregon.
Evergreen Health, Kirkland, Washington.
J Urol. 2022 Dec;208(6):1268-1275. doi: 10.1097/JU.0000000000002929. Epub 2022 Aug 19.
As the prevalence of urolithiasis increases and ureteroscopy is used more frequently, the risks of uncommon complications such as ureteral stricture may become more notable. Our objective is to assess the rate and associated risk factors of ureteral stricture formation in patients undergoing ureteroscopy.
Utilizing the IBM MarketScan research database, we evaluated data from 2008 to 2019 and compared ureteral stricture rates and their management following ureteroscopy to subjects who had shock wave lithotripsy. Shock wave lithotripsy was used as a comparison group to represent the rate of stricture from stone disease alone. A third group of those having both shock wave lithotripsy and ureteroscopy was included. Patients and secondary procedures were identified using Current Procedural Terminology, and International Classification of Diseases-9 and -10 codes.
A total of 329,776 patients received ureteroscopy, shock wave lithotripsy, or shock wave lithotripsy+ureteroscopy between 2008 and 2019. Stricture developed in 2.9% of patients after ureteroscopy, 1.5% after shock wave lithotripsy, and 2.6% after shock wave lithotripsy+ureteroscopy. In the multivariable model, rates of stricture were 1.7-fold higher after ureteroscopy vs shock wave lithotripsy (OR:1.71, 95% CI 1.62-1.81). Preoperative hydronephrosis, age, prior stones/intervention, and concurrent kidney and ureteral stones were associated with increased risk of stricture. Of those with strictures incurred after ureteroscopy, 35% required drainage, 21% had endoscopic intervention, 4.8% required reconstructive surgery, and 1.7% underwent nephrectomy.
Ureteral stricture rate after ureteroscopy of nearly 3% was higher than expected and approximately twice the rate attributable to stone disease alone. Factors associated with the stone as well as instrumentation were found to be risk factors. The morbidity of stricture disease following ureteroscopy was significant.
随着尿路结石发病率的增加和输尿管镜检查的广泛应用，输尿管狭窄等罕见并发症的风险可能变得更加显著。我们的目的是评估接受输尿管镜检查的患者中输尿管狭窄形成的发生率和相关的危险因素。
利用 IBM MarketScan 研究数据库，我们评估了 2008 年至 2019 年的数据，并将输尿管镜检查后输尿管狭窄的发生率及其治疗方法与接受体外冲击波碎石术的患者进行了比较。体外冲击波碎石术被用作单独结石疾病导致狭窄的对照组。还包括了同时接受体外冲击波碎石术和输尿管镜检查的第三组患者。患者和次要手术是通过当前操作术语 (Current Procedural Terminology) 和国际疾病分类第 9 版和第 10 版 (International Classification of Diseases-9 and -10 codes) 代码来确定的。
2008 年至 2019 年期间，共有 329776 例患者接受了输尿管镜检查、体外冲击波碎石术或体外冲击波碎石术联合输尿管镜检查。输尿管镜检查后 2.9%的患者出现狭窄，体外冲击波碎石术后 1.5%的患者出现狭窄，体外冲击波碎石术联合输尿管镜检查后 2.6%的患者出现狭窄。在多变量模型中，输尿管镜检查后狭窄的发生率是体外冲击波碎石术的 1.7 倍（比值比：1.71，95%置信区间：1.62-1.81）。术前肾积水、年龄、既往结石/干预、同时存在肾结石和输尿管结石与狭窄风险增加相关。在接受输尿管镜检查后发生狭窄的患者中，35%需要引流，21%需要内镜干预，4.8%需要重建手术，1.7%需要肾切除术。
输尿管镜检查后输尿管狭窄的发生率接近 3%，高于预期，约为单纯结石疾病导致狭窄发生率的两倍。与结石以及器械相关的因素被认为是危险因素。输尿管镜检查后狭窄疾病的发病率很高。
