Lazarovich Alon, Haramaty Rennen, Shvero Asaf, Zilberman Dorit E, Dotan Zohar A, Winkler Harry, Kleimann Nir
Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel.
The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Life (Basel). 2023 Oct 5;13(10):2019. doi: 10.3390/life13102019.
Primary ureteroscopy with laser lithotripsy is the treatment of choice for distal ureteral stones. However, in cases of proximal ureteral stones, some urologists recommend the preliminary insertion of a ureteral stent and deferred ureteroscopy. We aimed to evaluate the necessity of preliminary ureteral stent insertion in the management of proximal ureteral stones by comparing the surgical outcomes of patients undergoing primary ureteroscopy with laser lithotripsy for proximal vs. distal ureteral stones.
Medical records of patients who underwent ureteroscopy between 2016 and 2017 in our institution were retrospectively reviewed. Data collected included demographic data, stone size, renal function, intra- and post-operative complications, and stone-free rate (SFR). Patients were divided into two groups: proximal ureteral stones and distal ureteral stones.
The cohort included 241 patients who underwent ureteroscopy. Among them, 106 had a proximal ureteral stone. The median age was 51 (IQR 41-65) years. Patients who underwent ureteroscopy for proximal ureteral stones were significantly older ( = 0.007). The median stone's maximal diameter was 7 (5-10) mm. The complication rate and stone-free rate (SFR) were similar in both groups ( = 0.657 and = 1, respectively). The prevalence of post-procedural ureteral stent insertion was higher among patients who underwent ureteroscopy for proximal ureteral stones: 92.5% vs. 79.3% ( = 0.004).
Our study concludes that primary ureteroscopy with laser lithotripsy for proximal ureteral stones is a valid and feasible treatment with a similar surgical outcome compared to distal ureteral stones. Preliminary ureteral stent insertion seems to be unnecessary.
原发性输尿管镜激光碎石术是治疗远端输尿管结石的首选方法。然而，对于近端输尿管结石病例，一些泌尿外科医生建议先插入输尿管支架，然后延期进行输尿管镜检查。我们旨在通过比较原发性输尿管镜激光碎石术治疗近端与远端输尿管结石患者的手术结果，评估在近端输尿管结石治疗中预先插入输尿管支架的必要性。
回顾性分析2016年至2017年在我院接受输尿管镜检查的患者的病历。收集的数据包括人口统计学数据、结石大小、肾功能、术中及术后并发症以及结石清除率（SFR）。患者分为两组：近端输尿管结石组和远端输尿管结石组。
该队列包括241例行输尿管镜检查的患者。其中，106例患有近端输尿管结石。中位年龄为51岁（四分位间距41 - 65岁）。因近端输尿管结石接受输尿管镜检查的患者年龄显著更大（P = 0.007）。结石最大直径的中位数为7（5 - 10）mm。两组的并发症发生率和结石清除率（SFR）相似（分别为P = 0.657和P = 1）。因近端输尿管结石接受输尿管镜检查的患者术后输尿管支架置入率更高：92.5% 对79.3%（P = 0.004）。
我们的研究得出结论，原发性输尿管镜激光碎石术治疗近端输尿管结石是一种有效且可行的治疗方法，与远端输尿管结石相比手术结果相似。预先插入输尿管支架似乎没有必要。
