Clinical experiences of ureteral stricture with calculi treated by flexible ureteroscope sheath dilatation

doi:10.3877/cma.j.issn.1674-3253.2021.03.010

Abstract

Abstract:

Objective

To investigate the feasibility of flexible ureteroscope sheath dilatation in the treatment of ureteral stricture with calculi.

Methods

A total of 72 patients with ureteral stricture and calculi were treated by flexible ureteroscope sheath dilatation from March 2017 to August 2019, 30 patients were male, 42 patients were female, average age (49±9) years. The rigid ureteroscopy was used for exploration,an indwelling guide wire was placed to introduce the sheath of the flexible ureteroscopy, dilation step by step. By the holmium laser, the stones were fragmented. The calculi clearance rate and restenosis rate were evaluated at 3, 6 and 12 months after surgery.

Results

48 cases were managed by one-stage operation, 20 cases were managed by second-stage operation, 4 cases of the patients had to convert into surgery approach, The success rate of operation was 94.4%(68/72). The operation time was (65±24) minutes, Clavien classification grade (Classification of surgical complications) Ⅰ-Ⅱ were occurred in 72 patients, grade Ⅲ-Ⅳ in 0 patient. Stone free rate was 94.4%(68/72). After 3 months, the recurrence of ureteral stricture rate was 5.6%(4/72), After 6 months, the recurrence of ureteral stricture rate was 6.9%(5/72), one year later, the recurrence of ureteral stricture rate was 8.3%(6/72).

Conclusion

The flexible ureteroscope sheath dilatation is safe and effective in the treatment of ureteral stricture with calculi.

Key words: Ureteral stricture, Ureteral flexible sheath, Holmium laser

Liang Chen, Rentao Zhang, Yingman Ding, Zhengquan Wang. Clinical experiences of ureteral stricture with calculi treated by flexible ureteroscope sheath dilatation[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 226-228.

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References 11

[1]	何永忠，李逊，杨炜青, 等. 电刀内切开联合球囊扩张治疗输尿管狭窄[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(2): 37-40.
[2]	吕远，许长宝，马静, 等. "一步法"输尿管软镜治疗嵌顿性输尿管上段结石的临床分析[J]. 中华泌尿外科杂志, 2017, 38(5): 371-374.
[3]	朱峰，陈帅奇，侯国栋, 等. 无扩张鞘下输尿管软镜钬激光治疗≤2 cm肾结石的可行性研究[J]. 现代泌尿外科杂志, 2017, 22(12): 907-910.
[4]	刘海超，许长宝，赵兴华, 等. 注射器注水法输尿管软镜术中肾盂压力测定的安全性评价[J]. 中华泌尿外科杂志, 2016, 37(2): 135-138.
[5]	李武学，赵兴华，许长宝, 等. "空气减压"注射器注水法在输尿管软镜钬激光碎石术中的应用[J]. 中国全科医学, 2017, 20(29): 3703-3706.
[6]	王成路，金露，薛波新, 等. 术前预测输尿管嵌顿性结石的临床因素分析[J]. 中华泌尿外科杂志, 2019, 40(1): 42-46．
[7]	李瑞鹏，诸靖宇，宋晨, 等. 双J管在上尿路结石合并输尿管狭窄患者中的应用[J]. 浙江临床医学, 2017, 19(4): 658-659.
[8]	刘杰，薛江辉，冉光勇, 等. 同侧两根双J管引流在结石伴息肉导致输尿管狭窄患者中的应用[J/CD]. 中华腔镜泌尿外科杂志（电子版）, 2019, 13(4): 251-254.
[9]	李峰，符二，曹治列, 等. 同侧两根双J管在输尿管镜钬激光碎石术后的应用效果[J]. 浙江临床医学, 2017, 19(5): 859-861.
[10]	李武学，赵兴华，许长宝, 等. 输尿管镜治疗复杂性输尿管结石留置双J管时间的临床观察[J]. 实用医学杂志, 2017, 33(2): 256-258.
[11]	Reus C, Brehmer M. Minimally invasive management of ureteral strictures: a 5-year retrospective study[J]. World J Urol, 2019, 37(8): 1733-1738.

并发症		例数	发生率（%）
ClavienⅠ-Ⅱ级并发症
	疼痛、膀胱刺激症状	22	30.6%（22/72）
	发热	7	9.7%（7/72）
	输尿管、肾脏挫伤	20	27.8%（20/72）
	肉眼血尿	58	80.6%（58/72）

并发症		例数	发生率（%）
ClavienⅠ-Ⅱ级并发症
	疼痛、膀胱刺激症状	22	30.6%（22/72）
	发热	7	9.7%（7/72）
	输尿管、肾脏挫伤	20	27.8%（20/72）
	肉眼血尿	58	80.6%（58/72）

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[2]	Xiaoshan Li, Wei Liu, Shiping Wei. Clinical application of double J-Folys catheter binding complex in ureteroscopic holmium laser lithotripsy [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 154-156.
[3]	Jingmiao Jin, Wei Wei, Yuxiang Zhong, Yuan Mai, Jianhua Huang, Pengpeng Zhao, Fuxiang Lin, Kuangyi Li, Zhanping Xu. Clinical study of MPCNL combined with lateral positional Y-type negative pressure suction sheath for staghorn calculi in middle-aged and elderly patients [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 144-148.
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[6]	Aimaier Aihemaiti·, Simayi Abulizi·, Peng Lei, Tayier Talaiti·, Xiaoan Zhang, Alimu Yalikun·, Bin Wen, Mao Tang. Clinical analysis of flexible ureteroscope with holmium laser incision for treatment of renal parapelvic cyst [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(04): 339-342.
[7]	Chundong Ji, Jianyu Wang, Kai Liu. Efficacy of modified holmium laser lithotripsy combined with stone basket for complex upper ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(01): 60-63.
[8]	Shoudong Yang, Dongming Xiao, Jie Situ, Cheng Hu, Hao Zhang. Clinical effect of occluder combined with holmium laser in the treatment of upper and middle ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 511-515.
[9]	Binbin Gong, Zhengyao Song, Yucheng Xu, Jianzhong Wang, Song Fan, Chaozhao Liang, Zongyao Hao. Application of 6.0/7.5 F ureteroscope combined with 200 μm holmium laser in the treatment of middle and lower ureteral calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 507-510.
[10]	Jidong Xu, Ning Jiang, Chuanyi Hu, Jing Zhang, Jingcun Zheng, Jian Chu, He Zhang, Xiangmin Zhang, Chuanmin Chu, Xingang Cui. Preliminary experiences of moses laser enucleation of the prostate (MoLEP) in the treatment of massive prostatic hyperplasia [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 484-487.
[11]	Fan Yang, Xuwei Lu, Zhuifeng Guo, Yang He, Bingde Yin, Liang Qin, Hang Wang, Jiawen Wu. Clinical efficacy of presetting double J tube and using ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal pelvis calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(05): 423-427.
[12]	Liang Cui, Chunlong Fu, Xiaofei Dai, Xun Zhang, Wanlin Jing, Xiaojun Sun, Jingmin Li. Evaluation of the efficacy and safety of flexible ureterorenoscopy in the treatment of renal calculi larger than 3 cm [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(04): 222-226.
[13]	Dexin Li, Chengjin Mou, Fei Li, Maode Li. Holmium laser for inflammatory columnar bile duct stricture: a preliminary study [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(12): 1207-1210.
[14]	Zhongxiao Yan. Comparative study on transurethral holmium laser resection and plasmakinetic resection in treatment of benign prostatic hyperplasia in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 42-45.
[15]	Qingfeng Tang, Xiaoke Huang, Chengwan Liu, Weiqi Lai, Liang Li. Clinical analysis of low-powered holmium laser enucleation of prostate for benign prostatic hyperplasia in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 37-41.

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