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输尿管镜检查(URS)及结石治疗在复发性尿路感染患者中的作用:10年随访结果

Role of Ureteroscopy (URS) and Stone Treatment in Patients with Recurrent UTIs: Outcomes over a 10-Year Period.

作者信息

Ripa Francesco, Massella Virginia, Ong Andrea, Mani Sinha Mriganka, Pietropaolo Amelia, Somani Bhaskar K

机构信息

Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.

出版信息

J Clin Med. 2023 May 22;12(10):3591. doi: 10.3390/jcm12103591.

Abstract

. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. . We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. . Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7-17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, = 0.005). . SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS.

摘要

该研究旨在评估肾结石的清除是否可能导致复发性尿路感染的发病率大幅降低。我们选取了2012年至2021年间因结石疾病接受输尿管镜检查(URS)的所有患者,这些患者有复发性尿路感染(rUTIs)、尿脓毒症病史或术前尿培养(UC)阳性。数据包括患者人口统计学资料、微生物学数据、结石参数、随访时的无结石和无感染率(分别为SFR和IFR),无结石定义为影像学检查显示碎片<2mm,且无症状且尿培养证实无UTI。总体而言,共选取了178例患者。中位年龄为62岁。结石累积大小的中位数为10mm(7 - 17.25),最常见的部位是下极(18.9%)和输尿管近端(14.9%)。随访时的总体无结石率为89.3%。3个月时的IFR为88.3%。随着随访时间延长,IFR在6、12、18和24个月时分别降至85.4%、74.2%、68%和65%。与随访时无感染的患者相比,有感染复发的患者更有可能出现结石持续存在或复发(20%对4.4%,P = 0.005)。URS后的SFR是URS时rUTI或UC阳性患者随访时无感染状态可能性的一个重要预测变量。

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