{"title":"柔性真空辅助UAS与MPCNL治疗输尿管上段结石:一项前瞻性、随机对照研究。","authors":"Qing-Lai Tang, Ping Liang, Ling-Hui Li, Tian-Xiao Yang, Du-Jian Wang, Xing-Zhu Zhou, Rong-Zhen Tao","doi":"10.1007/s00240-025-01781-6","DOIUrl":null,"url":null,"abstract":"<p><p>To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with impacted upper ureteral stones (IUUS). The study included 189 patients, of which 95 were included in the FV-UAS group and 94 in the MPCNL group. The primary study outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary outcomes included the total SFRs 1 month postoperatively, operative time, reduction in hemoglobin levels, length of postoperative hospital stay, improvement in the quality of life as measured by the QoL score, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (P > 0.05). The mean decrease in hemoglobin was significantly lower in the FV-UAS group than in the MPCNL group (5.1 vs. 14.7 g/L, P < 0.001). Similarly, the FV-UAS group had a shorter average hospital stay than the MPCNL group (2.7 vs. 4.9 days, P < 0.001). However, SFRs at the first postoperative day and 4 weeks postoperatively were statistically similar between the two groups (P > 0.05). QoL improvement, measured by the QoL score, was significantly higher in the FV-UAS group than in the MPCNL group (32.5 vs. 27.1, P < 0.001). At 3 months postoperatively, the difference between two groups in the terms of ureteral stricture was not statistically significant (P > 0.05). Notablely, the overall rate of postoperative complications was markedly lower in the FV-UAS group than in the MPCNL group (P < 0.001). Our study revealed that RIRS with FV-UAS is a promising approach to treat IUUS, achieving satisfactory SFRs compared to MPCNL and notable improvements in QoL with a low complication rate.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"105"},"PeriodicalIF":2.0000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"RIRS with flexible vacuum-assisted UAS versus MPCNL for impacted upper ureteral stones: a prospective, randomized controlled study.\",\"authors\":\"Qing-Lai Tang, Ping Liang, Ling-Hui Li, Tian-Xiao Yang, Du-Jian Wang, Xing-Zhu Zhou, Rong-Zhen Tao\",\"doi\":\"10.1007/s00240-025-01781-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with impacted upper ureteral stones (IUUS). The study included 189 patients, of which 95 were included in the FV-UAS group and 94 in the MPCNL group. The primary study outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary outcomes included the total SFRs 1 month postoperatively, operative time, reduction in hemoglobin levels, length of postoperative hospital stay, improvement in the quality of life as measured by the QoL score, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (P > 0.05). The mean decrease in hemoglobin was significantly lower in the FV-UAS group than in the MPCNL group (5.1 vs. 14.7 g/L, P < 0.001). Similarly, the FV-UAS group had a shorter average hospital stay than the MPCNL group (2.7 vs. 4.9 days, P < 0.001). However, SFRs at the first postoperative day and 4 weeks postoperatively were statistically similar between the two groups (P > 0.05). QoL improvement, measured by the QoL score, was significantly higher in the FV-UAS group than in the MPCNL group (32.5 vs. 27.1, P < 0.001). At 3 months postoperatively, the difference between two groups in the terms of ureteral stricture was not statistically significant (P > 0.05). Notablely, the overall rate of postoperative complications was markedly lower in the FV-UAS group than in the MPCNL group (P < 0.001). Our study revealed that RIRS with FV-UAS is a promising approach to treat IUUS, achieving satisfactory SFRs compared to MPCNL and notable improvements in QoL with a low complication rate.</p>\",\"PeriodicalId\":23411,\"journal\":{\"name\":\"Urolithiasis\",\"volume\":\"53 1\",\"pages\":\"105\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-06-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urolithiasis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00240-025-01781-6\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urolithiasis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00240-025-01781-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
观察逆行肾内手术(RIRS)联合柔性真空辅助输尿管通路鞘(FV-UAS)和微创经皮肾镜取石术(MPCNL)治疗冲击型输尿管上段结石(IUUS)的疗效和安全性。该研究纳入189例患者,其中95例为FV-UAS组,94例为MPCNL组。主要研究结果是术后第一天的无结石率(SFRs)。次要结局包括术后1个月总SFRs、手术时间、血红蛋白水平降低、术后住院时间、生活质量改善(以生活质量评分衡量)、术后3个月输尿管狭窄发生率以及任何手术相关并发症。两组患者人口学特征及术前临床特征比较,差异无统计学意义(P < 0.05)。FV-UAS组血红蛋白平均下降量明显低于MPCNL组(5.1 g/L vs. 14.7 g/L, P < 0.05)。以生活质量评分衡量,FV-UAS组的生活质量改善明显高于MPCNL组(32.5比27.1,P 0.05)。值得注意的是,FV-UAS组术后并发症发生率明显低于MPCNL组(P
RIRS with flexible vacuum-assisted UAS versus MPCNL for impacted upper ureteral stones: a prospective, randomized controlled study.
To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with impacted upper ureteral stones (IUUS). The study included 189 patients, of which 95 were included in the FV-UAS group and 94 in the MPCNL group. The primary study outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary outcomes included the total SFRs 1 month postoperatively, operative time, reduction in hemoglobin levels, length of postoperative hospital stay, improvement in the quality of life as measured by the QoL score, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (P > 0.05). The mean decrease in hemoglobin was significantly lower in the FV-UAS group than in the MPCNL group (5.1 vs. 14.7 g/L, P < 0.001). Similarly, the FV-UAS group had a shorter average hospital stay than the MPCNL group (2.7 vs. 4.9 days, P < 0.001). However, SFRs at the first postoperative day and 4 weeks postoperatively were statistically similar between the two groups (P > 0.05). QoL improvement, measured by the QoL score, was significantly higher in the FV-UAS group than in the MPCNL group (32.5 vs. 27.1, P < 0.001). At 3 months postoperatively, the difference between two groups in the terms of ureteral stricture was not statistically significant (P > 0.05). Notablely, the overall rate of postoperative complications was markedly lower in the FV-UAS group than in the MPCNL group (P < 0.001). Our study revealed that RIRS with FV-UAS is a promising approach to treat IUUS, achieving satisfactory SFRs compared to MPCNL and notable improvements in QoL with a low complication rate.
期刊介绍:
Official Journal of the International Urolithiasis Society
The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field.
Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.