比较经逆行输尿管支架或经皮肾造瘘术后急诊引流后再次发生尿脓毒血症的患者行输尿管软镜碎石术治疗上尿路结石的效果。

A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy.

机构信息

Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China.

Department of General Surgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK.

出版信息

BMC Urol. 2023 Nov 28;23(1):196. doi: 10.1186/s12894-023-01369-5.

DOI:10.1186/s12894-023-01369-5

PMID:38017464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10685477/

Abstract

BACKGROUND

Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage.

OBJECTIVE

To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN).

METHOD

Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis.

RESULTS

A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay.

CONCLUSION

Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.

摘要

背景

患有上尿路结石合并脓毒症的患者在紧急引流后需要进一步进行结石处理。

目的

评估对接受逆行输尿管支架（RUS）或经皮肾造瘘术（PCN）紧急引流治疗脓毒症的上尿路结石患者进行择期软性输尿管镜碎石术（F-URSL）治疗上尿路结石的安全性和有效性。

方法

2017 年 1 月至 2021 年 12 月，对 102 例因上尿路或肾结石引起的脓毒症接受紧急引流后行择期 F-URSL 的患者进行了临床资料收集。根据引流方法将患者分为两组：RUS 组和 PCN 组。收集的资料包括患者的人口统计学资料、结石参数、紧急引流后感染恢复情况以及 F-URSL 后的临床结果。然后对资料进行了统计学分析。

结果

共有 102 例患者纳入统计分析，其中 RUS 组 58 例（56.86%），PCN 组 44 例（43.14%）。患者中女性 84 例（82.35%），男性 18 例（17.65%），平均年龄 59.36 岁。71 例（69.61%）患者的尿液培养阳性。两组患者均成功引流，引流后白细胞计数（WBC）和体温恢复正常所需的时间无显著差异。所有患者均成功进行了 F-URSL 手术，两组间手术时间、结石清除率、术后发热和术后住院时间无统计学差异。