Jarral Farhan, Hamdy Abdelrahman, Wrazen Jakub, Mohamed Guleed, Abusanad Osama
Urology, Doncaster Royal Infirmary, Doncaster, GBR.
General Surgery, Doncaster Royal Infirmary, Doncaster, GBR.
Cureus. 2024 Aug 14;16(8):e66845. doi: 10.7759/cureus.66845. eCollection 2024 Aug.
Introduction Currently, there are no agreed-upon investigations and follow-up guidelines for the conservative management of ureteric stones. This study used common themes identified in previous works to investigate whether there is a consensus amongst urology consultants in the United Kingdom. Methods This was a questionnaire-based survey study. An online questionnaire was disseminated nationally to urological consultants practicing in the United Kingdom to explore a range of common factors. The initial sample size was 81 UK-based urological consultants with an interest in endourology and stone surgery. Of the initial 81, 20 participants did not complete the survey and therefore the final sample size was 61. Descriptive analysis was used to analyze the data. Results Our survey found that the main factors influencing the follow-up of conservatively managed ureteric stones were stone size 98% (60), stone location 92% (56), and the degree of altered renal function 79% (48). Regardless of stone size, most participants chose to follow up at 2-4 weeks with asymptomatic patients requiring imaging with discrepancies about the modality. Regarding biochemical markers, most participants only repeated renal function tests if this was deranged on presentation. Calcium and uric acid levels were checked regularly. Diclofenac was the analgesia of choice 93% (55). Regarding the availability of acute ESWL services, over half (59%) were able to offer acute ESWL within the week. The majority offer services at least three or more lists per week. Conclusion Our results demonstrate that there is still no overarching consensus in the follow-up of conservatively managed ureteric stones. Several factors backed by high-level evidence are already consistent across the population of urology consultants and considered "best practice." However, before any all-encompassing national guidelines are formalized, further studies in the form of randomized control trials will be needed to yield high-level evidence.
引言 目前，对于输尿管结石的保守治疗，尚无公认的检查及随访指南。本研究利用先前研究中确定的共同主题，调查英国泌尿外科顾问之间是否存在共识。方法 这是一项基于问卷调查的研究。通过在线问卷在全国范围内向英国执业的泌尿外科顾问发放，以探讨一系列常见因素。初始样本量为81名对腔内泌尿外科和结石手术感兴趣的英国泌尿外科顾问。最初的81名参与者中，有20人未完成调查，因此最终样本量为61人。采用描述性分析对数据进行分析。结果 我们的调查发现，影响输尿管结石保守治疗随访的主要因素为结石大小（98%，60人）、结石位置（92%，56人）和肾功能改变程度（79%，48人）。无论结石大小如何，大多数参与者选择在2 - 4周对无症状患者进行随访，对于需要成像检查的患者，在检查方式上存在差异。关于生化指标，大多数参与者仅在初次检查时肾功能紊乱时才重复进行肾功能检查。定期检查钙和尿酸水平。双氯芬酸是93%（55人）的首选镇痛药。关于急性体外冲击波碎石术（ESWL）服务的可及性，超过一半（59%）的人能够在一周内提供急性ESWL服务。大多数人每周至少提供三个或更多的手术安排。结论 我们的结果表明，对于输尿管结石保守治疗的随访，仍未达成总体共识。一些有高级别证据支持的因素在泌尿外科顾问群体中已经是一致的，并被视为“最佳实践”。然而，在任何全面的国家指南正式确定之前，需要以随机对照试验的形式进行进一步研究，以产生高级别证据。
