Geavlete P, Plesuvescu A, Stanescu F, Ene C, Mares C, Bulai C, Multescu R, Geavlete B
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania.
Maedica (Bucur). 2023 Dec;18(4):586-592. doi: 10.26574/maedica.2023.18.4.586.
Ureteroscopy (URS) is a commonly used procedure for the management of ureteral stones. While elective URS has been extensively studied, the literature on emergency URS remains limited. The aim of the present study is to evaluate the efficacy and safeness of URS performed in emergency settings and to determine the ideal candidates for this type of intervention. Patients who underwent URS for ureteral stones in a single healthcare unit, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation between April 2022 and March 2023. The study group was divided into two subgroups: group A (138 patients who underwent semirigid URS in an emergency setting) which was subdivided into group A1 (95 patients with stone on the distal ureter) and group A2 (43 patients with stone on the proximal ureter), and group B (151 patients who underwent a double J stent insertion). The success rate defined as stone fragmentation and resolution of renal obstruction, along with intraoperative and postoperative complications were assessed. A URS procedure was considered unsuccessful if either the instrument could not be passed to access the stone or it was deemed unsafe to perform the URS. In such cases, patients were managed by inserting a ureteric stent and scheduled for a subsequent procedure. It could be observed that most complications occurred in emergency ureteroscopy on distal ureter (95 cases) and the most severe ones on proximal ureter (two cases - Clavien 4). Double J stenting provided a reduced number of complications (51 cases). It should be mentioned that patients with emergency semirigid ureteroscopy had more complications than those with double J stent for every group of BMI, while most of the complications were observed in the groups with the highest BMI. The success of the URS procedure was determined based on complete stone fragmentation and extraction, and it was of 91.3% for cases with emergency ureteroscopy. Patients who underwent URS for ureteral stones at a single facility, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation. The success rates and complication rates of emergency URS were comparable to those of elective URS, providing valuable insights for clinical decision-making.
输尿管镜检查（URS）是治疗输尿管结石常用的手术方法。虽然择期输尿管镜检查已得到广泛研究，但关于急诊输尿管镜检查的文献仍然有限。本研究的目的是评估在急诊情况下进行输尿管镜检查的有效性和安全性，并确定这类干预措施的理想人选。2022年4月至2023年3月期间，对罗马尼亚布加勒斯特“圣约翰”急诊临床医院这一单一医疗机构中因输尿管结石接受输尿管镜检查的患者进行了一项回顾性调查。研究组分为两个亚组：A组（138例在急诊情况下接受半硬性输尿管镜检查的患者），该组又细分为A1组（95例输尿管远端结石患者）和A2组（43例输尿管近端结石患者），以及B组（151例接受双J支架置入术的患者）。评估了定义为结石碎裂和肾梗阻解除的成功率以及术中及术后并发症。如果器械无法通过以接近结石或认为进行输尿管镜检查不安全，则输尿管镜检查手术被视为不成功。在这种情况下，患者通过插入输尿管支架进行处理，并安排后续手术。可以观察到，大多数并发症发生在输尿管远端的急诊输尿管镜检查中（95例），最严重的并发症发生在输尿管近端（2例——Clavien 4级）。双J支架置入术的并发症数量较少（51例）。应该提到的是，对于每组体重指数（BMI）而言，急诊半硬性输尿管镜检查的患者比双J支架置入术的患者并发症更多，而大多数并发症出现在BMI最高的组中。输尿管镜检查手术的成功是根据结石完全碎裂和取出确定的，急诊输尿管镜检查病例的成功率为91.3%。对罗马尼亚布加勒斯特“圣约翰”急诊临床医院这一单一医疗机构中因输尿管结石接受输尿管镜检查的患者进行了一项回顾性调查。急诊输尿管镜检查的成功率和并发症发生率与择期输尿管镜检查相当，为临床决策提供了有价值的见解。
