Department of Urology, Ankara Etlik Integrated Health Campus, Ankara-Türkiye.
Department of Radiology, Ankara Guven Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):671-676. doi: 10.14744/tjtes.2024.67996.
The use of ureteral access sheaths (UAS), which offer advantages in flexible ureteroscopic lithotripsy (fURL), may lead to undesirable conditions such as ureteral injury, ischemia, and prolonged ureteral stenosis. The aim of this study was to investigate the effect of the distal ureteral lateralization angle on successful UAS placement.
We analyzed the data of patients who underwent fURL for kidney and/or proximal ureteral stones retrospectively. Based on the preoperative computed tomographic examinations of the patients, the bladder outlet was considered the zero point. We calculated the angle values between the horizontal axis passing through this point and the most lateralized point of the distal ureter. The patients were divided into two groups: those to whom UAS was successfully placed and those to whom UAS placement failed.
No significant difference was detected between the groups with successful UAS placement (n=36) and those without UAS placement (n=12) in terms of sex, laterality, localization, number of stones, stone burden, and bladder volumes evaluated with preoperative computed tomography (p>0.05). However, a significant difference was found between the two groups regarding age and distal ureteral lateralization angle (p<0.001, p=0.013).
The distal ureteral lateralization angle is considered to be an effective factor in the placement of UAS in patients scheduled for fURS.
输尿管导引鞘（UAS）的使用在软性输尿管镜碎石术（fURL）中具有优势，但可能导致输尿管损伤、缺血和输尿管狭窄等不良情况。本研究旨在探讨远端输尿管侧移角度对 UAS 成功放置的影响。
我们回顾性分析了因肾结石和/或肾盂上段结石接受 fURL 的患者的数据。基于患者的术前 CT 检查，将膀胱出口视为零点。我们计算了通过该点的水平轴与远端输尿管最侧移点之间的角度值。患者分为两组：UAS 成功放置组（n=36）和 UAS 放置失败组（n=12）。
在性别、侧别、定位、结石数量、结石负荷以及术前 CT 评估的膀胱容量方面，UAS 成功放置组（n=36）与 UAS 放置失败组（n=12）之间无显著差异（p>0.05）。然而，两组在年龄和远端输尿管侧移角度方面存在显著差异（p<0.001，p=0.013）。
远端输尿管侧移角度被认为是影响 fURS 患者 UAS 放置的一个有效因素。
