Alhefnawy Mohamed Abdelrahman, Abdelrahman Moaz Fathy Ismail, Abo-Elnasr Hosam Abdel-Fattah, Eldib Helmy Ahmed
Urology Department, Benha University, Benha, Qalubia, Egypt.
Urology Department, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK.
Urolithiasis. 2025 Jan 3;53(1):18. doi: 10.1007/s00240-024-01683-z.
Studies in literature discussed the drawbacks of the ureteral access sheath use in flexible ureteroscopy and in the same time mentioned the benefits of ureteral access sheath in decreasing the incidence of urosepsis and better stone free rate. In the current study we aim to compare between percutaneous nephrostomy tube (PCN) insertion before flexible ureteroscopy and conventional ureteral access sheath (UAS) flexible ureteroscopy in terms of safety, efficacy and perioperative outcomes. In all, 100 Patients aged 20 to 67 years with upper ureteric stones and mild hydronephrosis or renal pelvic stones less than 20 mm with mild hydronephrosis were randomized into 2 groups; patients undergoing PCN insertion before flexible ureteroscopy, and patients undergoing the conventional UAS flexible ureteroscopy. Patients with active urinary tract infection, patients with urinary diversions or malformations and patients with uncontrolled coagulable status were excluded from the study. Perioperative data were recorded. This study was conducted on 50 PCN group and 50 UAS group. Age varied from 20.0 to 67.0 years. Males consisted more than half of study groups, 52% of PCN group and 66% of UAS group. Weak significant difference was found in need for ureteral pre-operative stenting between groups (8% with PCN vs. 22% with UAS, p 0.04995). There was no significant difference between two groups in intra-operative complications (mucosal injury, failed operation, perforation, false passage and conversion to other procedure), but there was significant difference in bleeding between the groups (6% with PCN vs. 22% with UAS, p = 0.021). There was no significant difference between two groups in post-operative complications (infection, fever, pain, hematuria, other complications, stone free rate, readmission and stent duration), but there was significant decrease in operative time (48.85 ± 13.861 in PCN group versus 56.82 ± 14.61 in UAS group, p = 0.0003). We conclude that PCN insertion before flexible ureteroscopy provides a safe technique with comparable outcomes to UAS use.
文献研究讨论了输尿管通路鞘在软性输尿管镜检查中使用的缺点，同时提到了输尿管通路鞘在降低尿脓毒症发生率和提高结石清除率方面的益处。在本研究中，我们旨在比较在软性输尿管镜检查前插入经皮肾造瘘管（PCN）和传统输尿管通路鞘（UAS）辅助软性输尿管镜检查在安全性、有效性和围手术期结果方面的差异。总共100例年龄在20至67岁之间、患有上段输尿管结石且伴有轻度肾积水或肾盂结石直径小于20 mm且伴有轻度肾积水的患者被随机分为两组；一组是在软性输尿管镜检查前接受PCN插入的患者，另一组是接受传统UAS辅助软性输尿管镜检查的患者。患有活动性尿路感染、尿路改道或畸形的患者以及凝血状态未得到控制的患者被排除在研究之外。记录围手术期数据。本研究共纳入50例PCN组患者和50例UAS组患者。年龄范围为20.0至67.0岁。两个研究组中男性均占一半以上，PCN组为52%，UAS组为66%。两组之间在术前输尿管支架置入需求方面存在微弱的显著差异（PCN组为8%，UAS组为22%，p = 0.04995）。两组在术中并发症（黏膜损伤、手术失败、穿孔、假道形成和转为其他手术）方面无显著差异，但两组在出血方面存在显著差异（PCN组为6%，UAS组为22%，p = 0.021）。两组在术后并发症（感染、发热、疼痛、血尿、其他并发症、结石清除率、再次入院和支架留置时间）方面无显著差异，但手术时间有显著缩短（PCN组为48.85 ± 13.861，UAS组为56.82 ± 14.61，p = 0.0003）。我们得出结论，在软性输尿管镜检查前插入PCN提供了一种安全的技术，其结果与使用UAS相当。
