Tobe Taisuke, Inoue Takaaki, Yamamichi Fukashi, Tominaga Koki, Fujita Masaichiro, Fujisawa Masato, Miyake Hideaki
Department of Urology, Kobe University Graduate School of Medicine, Hyogo, Japan.
Department of Urology and Stone Center, Hara Genitourinary Hospital, Hyogo, Japan.
Can Urol Assoc J. 2024 Sep;18(9):E261-E268. doi: 10.5489/cuaj.8713.
A prolonged operative time of lithotripsy with ureteroscopy for urolithiasis increases the risk of infectious complications; however, few reports have investigated the factors prolonging the operative time for ureteral stones. We investigated the factors associated with longer operative time in ureteroscopy for ureteral stones.
This retrospective cohort study analyzed patients who underwent retrograde ureteroscopic lithotripsy for ureteral stones and achieved an endoscopic stone-free status between April 2019 and July 2022. Patients were classified into two groups based on an operative time of ≥90 minutes or <90 minutes. We compared the patient and stone characteristics and surgical outcomes, and investigated the factors associated with a prolonged operative time.
The cohort comprised 519 patients, with 58 patients in the group with an operative time of ≥90 minutes. Compared to the shorter operative time group, the longer operative time group had a significantly greater proportion of males, stone diameter, stone volume, and Hounsfield units of stone; additionally, the longer operative time group had higher prevalences of endoscopic findings of edema, polyps, and mucosa-stone adherence. Multivariable analysis showed that stone size >10 mm (odds ratio 4.05), polyps (odds ratio 2.40), and mucosal adherence (odds ratio 3.51) were significantly associated with an operative time exceeding 90 minutes. There were no significant differences between the two groups in the incidences of postoperative fever and systemic inflammatory response syndrome.
Stone size, endoscopic findings of polyps, and mucosa-stone adherence were independent factors associated with a longer operative time.
输尿管镜下碎石术治疗尿路结石的手术时间延长会增加感染并发症的风险；然而，很少有报告研究延长输尿管结石手术时间的因素。我们调查了输尿管镜治疗输尿管结石手术时间延长的相关因素。
这项回顾性队列研究分析了2019年4月至2022年7月期间接受逆行输尿管镜碎石术治疗输尿管结石并达到内镜无结石状态的患者。根据手术时间≥90分钟或<90分钟将患者分为两组。我们比较了患者和结石特征以及手术结果，并调查了与手术时间延长相关的因素。
该队列包括519名患者，其中手术时间≥90分钟的组有58名患者。与手术时间较短的组相比，手术时间较长的组男性比例、结石直径、结石体积和结石的亨氏单位明显更高；此外，手术时间较长的组内镜下水肿、息肉和黏膜结石粘连的发生率更高。多变量分析显示，结石大小>10 mm（比值比4.05）、息肉（比值比2.40）和黏膜粘连（比值比3.51）与手术时间超过90分钟显著相关。两组术后发热和全身炎症反应综合征的发生率没有显著差异。
结石大小、息肉的内镜表现和黏膜结石粘连是与手术时间延长相关的独立因素。
