Ansari Md Imran, Khan Sajjad Ahmed, Thakur Deepak K, Agrawal Chandra Shekhar
Department of Urology, Birat Medical College Teaching Hospital, Morang, Nepal.
Birat Medical College Teaching Hospital, Morang, Nepal.
Medicine (Baltimore). 2025 May 30;104(22):e42659. doi: 10.1097/MD.0000000000042659.
Renal stone surgery has been significantly improved by various techniques, with retrograde intrarenal surgery (RIRS) gaining prominence. One potential approach to optimize RIRS outcomes is pre-stenting, where a ureteral stent is inserted before the procedure. Previous studies have explored its potential benefits, but the results are varied. This study aims to evaluate the outcomes of RIRS in patients who underwent pre-stenting versus those who did not, focusing on operative time, access sheath insertion success, stone-free rate, and postoperative complications such as urinary tract infections (UTIs).
A randomized controlled trial was conducted at the Department of Urology, Birat Medical College and Teaching Hospital, Nepal. A total of 126 patients undergoing RIRS were divided into 2 groups: pre-stented (n = 75) and non-stented (n = 51). Pre-stenting involved the placement of a ureteral stent before surgery, while the non-stented group did not receive this intervention. Key outcome measures included success rates for access sheath insertion, stone-free rate post-surgery, operative time, and postoperative complications, especially UTI. Statistical analysis was performed using SPSS-26, with a P-value of≤ .05 considered statistically significant.
The pre-stented group showed a significantly shorter operative time (58.81 ± 16.21 min) compared to the non-stented group (68.65 ± 15.99 min; P = .001). Pre-stenting also resulted in a higher success rate for access sheath insertion (84.0% vs 58.8%, P = .002) and a higher stone-free rate (85.3% vs 64.7%, P = .007). In terms of intraoperative complications, the rates were similar between both groups (10.7% in pre-stented vs 13.7% in non-stented group, P = .603). The incidence of postoperative UTIs was slightly higher in the non-stented group (11.8% vs 5.3%, P = .190), though the difference was not statistically significant.
Pre-stenting prior to RIRS significantly enhances surgical outcomes, including improving access sheath insertion success, reducing operative time, and increasing the stone-free rate without a substantial increase in complications. These findings suggest that routine pre-stenting can be beneficial in patients undergoing RIRS for nephrolithiasis, leading to more efficient procedures and improved results.
各种技术已使肾结石手术有了显著改善，逆行性肾内手术（RIRS）日益突出。一种优化RIRS手术效果的潜在方法是术前置入支架，即在手术前插入输尿管支架。既往研究探讨了其潜在益处，但结果各异。本研究旨在评估接受术前置入支架与未接受术前置入支架的患者行RIRS的手术效果，重点关注手术时间、穿刺鞘置入成功率、结石清除率以及术后并发症，如尿路感染（UTIs）。
在尼泊尔比拉特医学院教学医院泌尿外科进行了一项随机对照试验。总共126例行RIRS的患者被分为两组：术前置入支架组（n = 75）和未置入支架组（n = 51）。术前置入支架是指在手术前放置输尿管支架，而未置入支架组未接受此干预。主要观察指标包括穿刺鞘置入成功率、术后结石清除率、手术时间以及术后并发症，尤其是UTI。使用SPSS - 26进行统计分析，P值≤0.05被认为具有统计学意义。
与未置入支架组（68.65±15.99分钟）相比，术前置入支架组的手术时间显著缩短（58.81±16.21分钟；P = 0.001）。术前置入支架还使穿刺鞘置入成功率更高（84.0%对58.8%，P = 0.002），结石清除率更高（85.3%对64.7%，P = 0.007）。在术中并发症方面，两组发生率相似（术前置入支架组为10.7%，未置入支架组为13.7%，P = 0.603）。未置入支架组术后UTI的发生率略高（11.8%对5.3%，P = 0.190），尽管差异无统计学意义。
RIRS术前置入支架可显著提高手术效果，包括提高穿刺鞘置入成功率、缩短手术时间以及提高结石清除率，且并发症无大幅增加。这些发现表明，对于接受RIRS治疗肾结石的患者，常规术前置入支架可能有益，可使手术更高效并改善结果。
