Analysis of success rate of ureteral access sheath insertion and efficacy of stage I flexible ureteroscopic lithotripsy for upper urinary calculi

doi:10.3877/cma.j.issn.1674-3253.2022.05.011

Abstract

Abstract:

Objective

To investigate the success rate of ureteral access sheath (UAS) insertion and efficacy of stage I flexible ureteroscopic lithotripsy (f-URL) in treatment of upper urinary calculi without indwelling double-J stent previously.

Methods

A total of 255 patients with upper urinary calculi treated by stage I f-URL in our hospital from January 2018 to June 2020 were analyzed retrospectively. The success rate of UAS insertion and surgery, the stone-free rate and the incidence of complications were calculated.

Results

The success rate of UAS insertion was 92.9%(237/255), and the success rate of one-stage operation was 85.5%(218/255). The success rate of UAS insertion in 10/12 F group was 91.6%(141/154), there was significant difference in gender between successful and unsuccessful patients (P<0.05). The success rate of UAS insertion in 12/14 F group was 95%(96/101), there was significant difference in hydronephrosis and preoperative renal function between successful and unsuccessful patients. Further multivariate logistic regression analysis showed that gender (P=0.014) were the risk factors for the failure of UAS insertion.The stone-free rate was 88.5%(177/200) three month after the operation. The total complication rate was 23.5%(60/255). During operation, there were 25 cases of grade 1 ureteral injury, 6 cases of grade 2 ureteral injury and 1 case of grade 3 ureteral injury. There were 22 cases of postoperative fever, including 5 cases of systemic inflammatory response syndrome and 1 case of urosepsis. Subcapsular hematoma occurred in 1 case. There were 5 cases of renal insufficiency, but no serious complications such as septic shock, ureteral stone street and ureteral stricture.

Conclusion

Stage I f-URL without indwelling double-J stent has a high success rate of UAS insertion and surgery with a high stone-free rate, is also a safe and reliable procedure. Female patients are more likely to experience intraoperative success to insert UAS.

Key words: Flexible ureteroscope, Efficacy, Ureteral access sheath, Gender

Feng Lin, Shuixiang Tao, Gang Wang, Jiadong Xu, Yiwei Lin, Xiangyi Zheng. Analysis of success rate of ureteral access sheath insertion and efficacy of stage I flexible ureteroscopic lithotripsy for upper urinary calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 432-436.

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References 18

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组别	例数	年龄[岁，(±s)]	性别(例)		身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾积水^*(例)			通道鞘型号(例)		术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
组别	例数	年龄[岁，(±s)]	男	女	身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	无/轻度	中度	重度	10/12 F	12/14 F	术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
成功组	237	49±14	165	72	1.54±0.44	23.4±4	1.27±0.52	213	21	3	141	96	55	4	25
失败组	18	50±12	17	1	1.66±0.09	24.1±3	1.11±0.35	14	3	1	13	5	7	1	1
统计值		t=-0.205	χ²=5.046		t=1.159	t=-0.806	t=1.195	Z=-1.615			χ²=1.133		χ²=1.465	-	χ²=0.073
P值		0.838	0.025		0.247	0.421	0.233	0.106			0.287		0.226	0.309	0.768

组别	例数	年龄[岁，(±s)]	性别(例)		身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾积水^*(例)			通道鞘型号(例)		术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
组别	例数	年龄[岁，(±s)]	男	女	身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	无/轻度	中度	重度	10/12 F	12/14 F	术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
成功组	237	49±14	165	72	1.54±0.44	23.4±4	1.27±0.52	213	21	3	141	96	55	4	25
失败组	18	50±12	17	1	1.66±0.09	24.1±3	1.11±0.35	14	3	1	13	5	7	1	1
统计值		t=-0.205	χ²=5.046		t=1.159	t=-0.806	t=1.195	Z=-1.615			χ²=1.133		χ²=1.465	-	χ²=0.073
P值		0.838	0.025		0.247	0.421	0.233	0.106			0.287		0.226	0.309	0.768

组别	例数	年龄[岁，(±s)]	性别(例)		身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾积水(例)			术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
组别	例数	年龄[岁，(±s)]	男	女	身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	无/轻度	中度	重度	术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
成功组	141	49±12	99	42	1.68±0.05	23.9±2.7	1.14±0.45	132	9	0	30	3	17
失败组	13	44±12	13	0	1.66±0.07	23.6±4.7	1.02±0.31	12	1	0	3	1	1
统计值		t=1.412	χ²=3.929		t=0.569	t=0.261	t=1.003	Z=-0.183			χ²=0.000	-	χ²=0.000
P值		0.16	0.047		0.570	0.798	0.317	0.855			1.000	0.300	0.986

组别	例数	年龄[岁，(±s)]	性别(例)		身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾积水(例)			术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
组别	例数	年龄[岁，(±s)]	男	女	身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	无/轻度	中度	重度	术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
成功组	141	49±12	99	42	1.68±0.05	23.9±2.7	1.14±0.45	132	9	0	30	3	17
失败组	13	44±12	13	0	1.66±0.07	23.6±4.7	1.02±0.31	12	1	0	3	1	1
统计值		t=1.412	χ²=3.929		t=0.569	t=0.261	t=1.003	Z=-0.183			χ²=0.000	-	χ²=0.000
P值		0.16	0.047		0.570	0.798	0.317	0.855			1.000	0.300	0.986

组别	例数	年龄[岁，(±s)]	性别(例)		身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾积水(例)			术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
组别	例数	年龄[岁，(±s)]	男	女	身高[m，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	无/轻度	中度	重度	术前肾功能异常(例)	输尿管扭曲(例)	糖尿病(例)
成功组	96	50±12	66	30	1.67±0.08	24.3±3.4	1.44±0.56	81	12	3	25	1	8
失败组	5	60±13	4	1	1.66±0.04	23.2±1.9	1.38±0.36	2	2	1	4	0	0
统计值		t=-1.841	χ²=0.001		t=-0.284	t=0.744	t=0.26	Z=-2.578			χ²=4.381	-	-
P值		0.069	0.793		0.777	0.459	0.795	0.010			0.036	1.000	1.000

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