Al-Naggar Khalil, Ahmed Faisal, Al-Kohlany Khaled, Alnadhari Ibrahim
Department of Urology, School of Medicine, Ibb University, Ibb.
Department of Urology, College of Medicine, Sana'a University, Sana'a.
Arch Ital Urol Androl. 2025 Jun 30;97(2):13759. doi: 10.4081/aiua.2025.13759. Epub 2025 May 5.
Data on complications associated with emergency ureteroscopy for ureteral stones are limited, particularly in developing countries. This study investigates factors contributing to complications in emergency ureteroscopy utilizing a pneumatic semirigid ureteroscope (URS).
This retrospective analysis included 266 patients with ureteral stones who underwent emergency ureteroscopy using a pneumatic semirigid URS from 2018 to 2023. We extracted comprehensive data on patient demographics, stone characteristics, intraoperative and postoperative complications, and stone-free rate (SFR) from medical records, subsequently subjected to statistical analysis. Factors linked to complications were explored through univariate and multivariate analyses.
The mean stone size was 9.1 ± 4.9 mm, with the majority (n = 181, 71.3%) located in the mid-ureter. The mean operative duration was 57.7 ± 7.3 min. The overall complication rate was 10.2%, with intraoperative complications in 16 patients (6.0%), including mucosal damage (3.4%), stone up-migration (3.0%), and one ureteral perforation (0.4%). Postoperative complications occurred in 13 patients (4.9%), primarily fever (2.6%), followed by hematuria (1.1%). Additional complications included febrile urinary tract infections (UTIs), pyelonephritis, and one mortality. The overall SFR was 85.3%, with 39 patients (14.7%) demonstrating residual stones. Significant predictive factors for complications included larger stone size (Adjusted Odds Ratio [AOR]: 1.3; 95% Confidence Interval [CI]: 1.15-1.39, p<0.0001) and proximal ureteral stones (AOR: 4.9; 95% CI: 1.31-18.23, p=0.0182).
Emergency ureteroscopy using a semirigid URS demonstrated favorable outcomes in treating ureteral stones, characterized by minimal complications and an acceptable SFR. Emphasizing appropriate instrument selection, surgical expertise, and technique is crucial in minimizing adverse events, particularly for large and upper ureteral stones.
关于输尿管结石急诊输尿管镜检查相关并发症的数据有限，尤其是在发展中国家。本研究调查了使用气动半硬性输尿管镜（URS）进行急诊输尿管镜检查时导致并发症的因素。
这项回顾性分析纳入了2018年至2023年期间266例因输尿管结石接受急诊输尿管镜检查并使用气动半硬性URS的患者。我们从病历中提取了关于患者人口统计学、结石特征、术中及术后并发症以及结石清除率（SFR）的综合数据，随后进行统计分析。通过单因素和多因素分析探索与并发症相关的因素。
平均结石大小为9.1±4.9毫米，大多数（n = 181，71.3%）位于输尿管中段。平均手术时长为57.7±7.3分钟。总体并发症发生率为10.2%，16例患者（6.0%）发生术中并发症，包括黏膜损伤（3.4%）、结石上移（3.0%）和1例输尿管穿孔（0.4%）。13例患者（4.9%）发生术后并发症，主要为发热（2.6%），其次为血尿（1.1%）。其他并发症包括发热性尿路感染（UTIs）、肾盂肾炎和1例死亡。总体SFR为85.3%，39例患者（14.7%）有残余结石。并发症的显著预测因素包括结石较大（调整优势比[AOR]：1.3；95%置信区间[CI]：1.15 - 1.39，p<0.0001）和输尿管上段结石（AOR：4.9；95%CI：1.31 - 18.23，p = 0.0182）。
使用半硬性URS进行急诊输尿管镜检查在治疗输尿管结石方面显示出良好的效果，并发症少且SFR可接受。强调合适的器械选择、手术专业知识和技术对于将不良事件降至最低至关重要，特别是对于较大和上段输尿管结石。
