Department of Urology Surgery, The First Affiliated Hospital of Shaoyang University, Shaoyang, P.R. China.
Department of Urology Surgery, Xiangya Hospital Central South University, Changsha, P.R. China.
J Endourol. 2024 Nov;38(11):1178-1184. doi: 10.1089/end.2023.0638. Epub 2024 Oct 3.
To analyze the influencing factors of ureteral stenosis after ureteroscopic holmium laser lithotripsy. The clinical data of 427 patients treated with ureteroscopic holmium laser lithotripsy were selected, and the patients were divided into two groups based on the presence or absence of ureteral stenosis after the operation. Univariate and multivariate logistic regression were used to analyze the independent risk factors for postoperative ureteral stenosis, and R software and regression coefficients were used to construct a predictive model. After a 1-year follow-up of 427 patients, 28 patients (6.56%) developed ureteral stenosis; univariate analysis showed that the occurrence of ureteral stenosis after subureteral holmium laser lithotripsy was related to stone diameter, stone incarceration, degree of hydronephrosis, holmium laser injury of mucosa, and operation time ( < 0.05); further logistic regression analysis showed that a large stone diameter, stone incarceration, and moderate to severe hydronephrosis were independent risk factors for ureteral stenosis after ureteroscopic holmium laser lithotripsy ( < 0.05); According to H-L deviation degree and area under receiver operating characteristic curve test, the results show that the model has high accuracy ( = 2.475, = 0.613) and differentiation (0.875 [95% confidence interval or CI: 0.817-0.919]), and the external verification of the nomogram prediction model was carried out by the verification group. The results showed that the prediction probability of the calibration curve was close to the actual probability and had a good consistency (area under the curve: 0.873 [95 CI: 0.822-0.914]). The established nomogram model exhibits high accuracy and discriminative ability. It can effectively identify high-risk groups, enabling timely prevention of ureteral stenosis and minimizing the risk of postoperative ureteral stenosis.
分析输尿管镜钬激光碎石术后输尿管狭窄的影响因素。选取 427 例行输尿管镜钬激光碎石术的患者临床资料，根据术后是否出现输尿管狭窄将患者分为两组。采用单因素和多因素 logistic 回归分析术后输尿管狭窄的独立危险因素，并用 R 软件和回归系数构建预测模型。对 427 例患者进行 1 年随访，28 例（6.56%）发生输尿管狭窄；单因素分析显示，输尿管下段钬激光碎石术后输尿管狭窄的发生与结石直径、结石嵌顿、肾积水程度、钬激光损伤黏膜及手术时间有关（ < 0.05）；进一步 logistic 回归分析显示，结石直径大、结石嵌顿、中度至重度肾积水是输尿管镜钬激光碎石术后发生输尿管狭窄的独立危险因素（ < 0.05）；根据 H-L 偏离度和受试者工作特征曲线下面积检验结果，提示模型具有较高的准确性（ = 2.475， = 0.613）和区分度（0.875[95%置信区间或 CI：0.817-0.919]），并通过验证组对列线图预测模型进行外部验证。结果表明，校准曲线的预测概率与实际概率接近，一致性较好（曲线下面积：0.873[95%CI：0.822-0.914]）。建立的列线图模型具有较高的准确性和区分度，能有效识别高危人群，及时预防输尿管狭窄的发生，降低术后输尿管狭窄的风险。
