Gauhar Vineet, Traxer Olivier, Sabnis Ravindra B, Fong Khi Yung, Gharia Parimalsinh, Grover Rishi, Ragoori Deepak, Lim Ee Jean, Tanidir Yiloren, Mehta Amish, Gökce Mehmet Ilker, Lakmichi Mohamed Amine, Soebhali Boyke, Gadzhiev Nariman, Chew Ben H, Somani Bhaskar Kumar, Castellani Daniele
Department of Urology, Ng Teng Fong General Hospital, Singapore.
Department of Urology AP HP, Tenon Hospital, Sorbonne University, Paris, France.
Indian J Urol. 2024 Oct-Dec;40(4):235-241. doi: 10.4103/iju.iju_38_24. Epub 2024 Oct 1.
We aimed to assess complications and stone-free rate of flexible ureteroscopy (FU) reusing disposable scopes (RDS) after repeated sterilization.
Data from adults from 11 centers were retrospectively reviewed (January 2020-December 2022). Inclusion criteria were proximal ureteral/renal stone(s). All cases were performed using an RDS to save costs for patients who come from economically challenged environments. Residual fragments (RFs) were defined as single fragment ≥4 mm or multiple fragments of any size within 3 months. Continuous variables are presented as median and interquartile range.
Two thousand one hundred and eighty-three patients were included, of whom 67.0% were male. Median age was 48.0 (36-59) years. The median stone diameter was 10.2 (9-14) mm. Flash sterilization was used in 90.2% (plasma in 60.5%). Approximately, 88% had FU with an RDS used ≤2 times (12%: 3-5 times). RDS needed to be changed intraoperatively in 3.9% of cases due to its malfunction. Commonly, defects in RDS function were reported in upward (1.6%) and downward deflection (6.5%) and image quality on white balancing (4.7%). Fever >38C was seen in 13.7% of cases, and sepsis in 0.5%. RFs were found in 31.4% of cases. Lower pole (odds ratio [OR] 5.63) or pelvis stone (OR 4.67), faulty scopes (OR 12.8), and total operation time (OR 1.05) were factors associated with higher odds of RFs. Stone size (OR 1.09), positive urine culture (OR 1.67), interpolar stone (OR 1.68), and prestenting (OR 1.37) were factors associated with higher odds of fever/sepsis.
RDS was used as a cost-conscious approach with a low rate of serious infections but with a high rate of RFs.
我们旨在评估重复灭菌后使用一次性输尿管镜（RDS）进行软性输尿管镜检查（FU）的并发症和结石清除率。
回顾性分析了11个中心2020年1月至2022年12月成年患者的数据。纳入标准为近端输尿管/肾结石。所有病例均使用RDS进行，以节省经济困难患者的费用。残余碎片（RFs）定义为3个月内单个碎片≥4 mm或任何大小的多个碎片。连续变量以中位数和四分位间距表示。
共纳入2183例患者，其中67.0%为男性。中位年龄为48.0（36 - 59）岁。结石中位直径为10.2（9 - 14）mm。90.2%使用快速灭菌（60.5%使用等离子灭菌）。约88%的患者使用RDS进行FU的次数≤2次（12%：3 - 5次）。3.9%的病例因RDS故障需要在术中更换。常见的RDS功能缺陷报告为向上偏转（1.6%）和向下偏转（6.5%）以及白平衡图像质量（4.7%）。13.7%的病例出现体温>38℃，0.5%出现脓毒症。31.4%的病例发现有RFs。下极结石（优势比[OR]5.63）或肾盂结石（OR 4.67）、有故障的输尿管镜（OR 12.8）以及总手术时间（OR 1.05）是与RFs发生率较高相关的因素。结石大小（OR 1.09）、尿培养阳性（OR 1.67）、极间结石（OR 1.68）以及预先放置支架（OR 1.37）是与发热/脓毒症发生率较高相关的因素。
RDS作为一种注重成本的方法，严重感染率较低，但RFs发生率较高。
