Morgan Kevin, Possoit HarLee, Conelly Zachary, Frilot Clifton F, Khater Nazih, Gomelsky Alexander
Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
School of Medicine, LSU Health Shreveport, Shreveport, USA.
Urolithiasis. 2023 Feb 28;51(1):41. doi: 10.1007/s00240-023-01410-0.
The risk of failed access (FA) in unstented ureteroscopy ranges from 7.7 to 16%, with young females and those with prior ipsilateral stone surgery, narrow ureteral anatomy, and proximal ureteral stone location carrying higher risk. We aim to determine the rate of failed access at our institution and analyze demographic, clinical, and operative variables associated with FA. We conducted a review of all unstented ureteroscopy procedures at our institution between January 2018 and June 2022. Ureteroscopy for stone, stricture, and neoplasm were included. The primary endpoint was rate of FA, when the unstented ureter failed to accommodate the ureteroscope distal to the target lesion. Demographic, clinical, and operative variables were analyzed to determine if there was an association with FA. Of the 562 ureteroscopies cases reviewed, 221 unstented ureteroscopies fit our inclusion criteria. FA occurred in 34 (15.4%). Previous stone passage (p = 0.039) and distal ureteral location (p = 0.042) were associated with successful access (SA). Proximal ureteral location was associated with FA (p = 0.008). These variables remained statistically significant when analyzed with multivariable logistic regression. There was no association with other demographic, clinical and operative variables. FA occurred at a rate of 15.4% at our institution. Previous stone passage and distal ureteral location were associated with SA, while proximal ureteral location was associated with FA. Prospective studies are needed to better determine predictors of FA.
无支架输尿管镜检查中入镜失败（FA）的风险为7.7%至16%，年轻女性、既往同侧有结石手术史者、输尿管解剖结构狭窄者以及输尿管近端结石患者的风险更高。我们旨在确定我院的入镜失败率，并分析与入镜失败相关的人口统计学、临床和手术变量。我们回顾了2018年1月至2022年6月期间我院所有无支架输尿管镜检查手术。包括针对结石、狭窄和肿瘤的输尿管镜检查。主要终点是入镜失败率，即无支架输尿管无法容纳输尿管镜到达目标病变远端时的情况。分析人口统计学、临床和手术变量以确定是否与入镜失败有关。在回顾的562例输尿管镜检查病例中，221例无支架输尿管镜检查符合我们的纳入标准。34例（15.4%）发生入镜失败。既往有结石排出史（p = 0.039）和输尿管远端位置（p = 0.042）与成功入镜（SA）相关。输尿管近端位置与入镜失败相关（p = 0.008）。当用多变量逻辑回归分析时，这些变量仍具有统计学意义。与其他人口统计学、临床和手术变量无关。我院入镜失败率为15.4%。既往有结石排出史和输尿管远端位置与成功入镜相关，而输尿管近端位置与入镜失败相关。需要进行前瞻性研究以更好地确定入镜失败的预测因素。
