Analysis of clinical factors predicting failure in primary ureteroscopy insertion during ureteroscopic lithotripsy

doi:10.3877/cma.j.issn.1674-3253.2020.04.010

Abstract

Abstract:

Objective

To explore the clinical factors related to the failure of ureteroscopy insertion due to small lumen of ureter during ureteroscopic lithotripsy.

Methods

The clinical data of patients underwent ureteroscopic lithotripsy by the same surgeon from May 2018 to August 2019 in our hospital were retrospectively analyzed. The 8/9.8 F hard ureteroscope was used for surgery. The patients were divided into 2 groups according to whether the ureteroscopy access through the ureter successfully and the clinical data were compared between the two groups.

Results

A total of 102 patients underwent ureteroscopy lithotripsy, including 91 cases of successful ureteroscopy insertion and 11 cases of failure. The failure rate of primary ureteroscopy insertion was 10.8%. There were no significant differences between the two groups in terms of age, sex, height, weight, BMI, incidence of diabetes, preoperative ESWL history, history of natural stone rowing, history of ureteroscopy and the longitudinal diameter of stone. The transverse diameter of stones in the successful group was significantly larger than that in the failure group [(7.7±1.4) mm vs (5.8±1.1) mm, P<0.001]; the failure rate of ureteroscopy insertion in patients with proximal ureteral stone was significantly higher (9/30=30%) than that with middle (1/27=3.7%) and lower (1/45=2.2%) ureteral stone (P<0.001). In patients with proximal ureteral stone, the transverse diameter of stones in the failed group was significantly smaller than that of the successful group [(5.9±1.2) mm vs (8.4±1.4) mm, P<0.001]. Further multivariate logistic regression analysis showed that the transverse diameter of the stones (P=0.027) and the position of the stones (P=0.042) were the risk factors for the failure of ureteroscopy insertion.

Conclusion

If the stone is located in the upper part of the ureter and the transverse diameter of the stone is small, the possibility of ureteroscopy access failure due to the small lumen is high. It should be fully estimated before surgery.

Key words: Stone, Ureteroscopy, Risk factors

Haiyun Xiong, Yiyu Sheng, Yupeng Feng, He Ma, Duanya Xu, Jun Pang, Jun Li. Analysis of clinical factors predicting failure in primary ureteroscopy insertion during ureteroscopic lithotripsy[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(04): 279-282.

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Figures/Tables 3

References 13

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组别	例数	性别（例）		年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	BMI（kg/m²，±s）	糖尿病史（例）	自然排石史（例）	输尿管镜手术史（例）	ESWL史（例）
组别	例数	男	女	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	BMI（kg/m²，±s）	糖尿病史（例）	自然排石史（例）	输尿管镜手术史（例）	ESWL史（例）
成功组	91	62	29	38±9	165±7	67±9	24±3	6	5	7	26
失败组	11	7	4	39±7	168±6	68±7	24±2	1	0	0	3
统计值	?	χ²=0.091		U=463.5	U=420.0	U=462.0	U=430	χ²=0.096	χ²=0.636	χ²=0.909	χ²=1.322
P值	?	0.763		0.689	0.384	0.677	0.447	0.757	0.425	0.341	0.250

组别	例数	性别（例）		年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	BMI（kg/m²，±s）	糖尿病史（例）	自然排石史（例）	输尿管镜手术史（例）	ESWL史（例）
组别	例数	男	女	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	BMI（kg/m²，±s）	糖尿病史（例）	自然排石史（例）	输尿管镜手术史（例）	ESWL史（例）
成功组	91	62	29	38±9	165±7	67±9	24±3	6	5	7	26
失败组	11	7	4	39±7	168±6	68±7	24±2	1	0	0	3
统计值	?	χ²=0.091		U=463.5	U=420.0	U=462.0	U=430	χ²=0.096	χ²=0.636	χ²=0.909	χ²=1.322
P值	?	0.763		0.689	0.384	0.677	0.447	0.757	0.425	0.341	0.250

组别	例数	结石纵径（mm，±s）	结石横径（mm，±s）	结石部位（例）
组别	例数	结石纵径（mm，±s）	结石横径（mm，±s）	上	中	下
成功组	91	11.1±1.6	7.7±1.4	21	26	44
失败组	11	10.3±1.3	5.8±1.1	9	1	1
统计值	?	U=357.5	U=154	χ²=16.349
P值	?	0.114	<0.001	<0.001

组别	例数	结石纵径（mm，±s）	结石横径（mm，±s）	结石部位（例）
组别	例数	结石纵径（mm，±s）	结石横径（mm，±s）	上	中	下
成功组	91	11.1±1.6	7.7±1.4	21	26	44
失败组	11	10.3±1.3	5.8±1.1	9	1	1
统计值	?	U=357.5	U=154	χ²=16.349
P值	?	0.114	<0.001	<0.001

相关因素		B	Wald	P值	OR	OR 95%置信区间
结石纵径		-0.021	0.001	0.974	0.979	0.281～3.415
结石横径		-4.144	4.898	0.027	0.016	0.000～0.622
年龄		0.079	0.523	0.470	1.082	0.874～1.341
性别		2.103	0.594	0.441	8.189	0.039～1719.355
身高		4.616	2.757	0.097	101.128	0.435～23525.450
体重		-5.749	2.836	0.092	0.003	0.000～2.566
糖尿病		-3.087	1.489	0.222	0.046	0.000～6.495
排石史		17.226	0.000	0.999	30280738.969	0.000～-
输尿管操作史		16.297	0.000	0.999	11962879.044	0.000～-
ESWL史		-2.147	1.082	0.298	0.117	0.002～6.679
结石部位		?	5.267	0.042	?	?
?	结石部位（1）	8.806	5.139	0.023	6671.855	3.295～13508695.496
?	结石部位（2）	0.925	0.139	0.709	2.521	0.020～324.780
BMI		16.303	2.929	0.087	12029858.832	0.094～1544587911328693.000

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