{"title":"输尿管镜碎石术中预测输尿管困难的临床因素。","authors":"Masashi Imano, Tadashi Tabei, Hiroki Ito, Junichi Ota, Kazuki Kobayashi","doi":"10.1155/2023/2584499","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for difficult ureters during ureteroscopic lithotripsy and to determine the appropriate indications for preoperative stenting.</p><p><strong>Methods: </strong>We retrospectively analyzed 156 ureteroscopic procedures for upper urinary tract stones after excluding those with preoperative stenting or percutaneous nephrostomy. Traceability of the ureter was assessed by two urologists. Traceability was defined as positive if either or both urologists discerned the ureter in all slices on preoperative plain computed tomography. Patients' backgrounds were compared between the nondifficult ureter and difficult ureter groups. A multivariate logistic regression model was used to evaluate the relationships between difficult ureters and other clinical factors.</p><p><strong>Results: </strong>Of 156 patients, 31 (19.9%) were classified into the difficult ureter group. The positive traceability was higher in the nondifficult ureter group (48.3% vs. 83.2%, <i>P</i> < 0.001). The major axis was smaller in the difficult ureter group than in the nondifficult ureter group (8.8 ± 3.9 mm vs. 10.9 ± 4.5 mm, <i>P</i> < 0.018). A major axis <8 mm (odds ratio: 4.495, 95% confidence interval: 1.791-11.278, and <i>P</i>=0.001), negative traceability (odds ratio: 7.565, 95% confidence interval: 2.693-21.248, and <i>P</i> < 0.001), smoking status (odds ratio: 3.196, 95% confidence interval: 1.164-8.773, and <i>P</i>=0.024), and absence of diabetes mellitus (odds ratio: 5.813, 95% confidence interval: 1.121-30.142, and <i>P</i>=0.036) were identified as independent predictors of difficult ureters on multivariate logistic regression analysis.</p><p><strong>Conclusion: </strong>Patients with smaller stones, negative traceability, ongoing tobacco consumption, and absence of diabetes mellitus were at higher risk of difficult ureters. In these patients, preoperative stenting may be considered.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911238/pdf/","citationCount":"1","resultStr":"{\"title\":\"Clinical Factors to Predict Difficult Ureter during Ureteroscopic Lithotripsy.\",\"authors\":\"Masashi Imano, Tadashi Tabei, Hiroki Ito, Junichi Ota, Kazuki Kobayashi\",\"doi\":\"10.1155/2023/2584499\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To identify risk factors for difficult ureters during ureteroscopic lithotripsy and to determine the appropriate indications for preoperative stenting.</p><p><strong>Methods: </strong>We retrospectively analyzed 156 ureteroscopic procedures for upper urinary tract stones after excluding those with preoperative stenting or percutaneous nephrostomy. Traceability of the ureter was assessed by two urologists. Traceability was defined as positive if either or both urologists discerned the ureter in all slices on preoperative plain computed tomography. Patients' backgrounds were compared between the nondifficult ureter and difficult ureter groups. A multivariate logistic regression model was used to evaluate the relationships between difficult ureters and other clinical factors.</p><p><strong>Results: </strong>Of 156 patients, 31 (19.9%) were classified into the difficult ureter group. The positive traceability was higher in the nondifficult ureter group (48.3% vs. 83.2%, <i>P</i> < 0.001). The major axis was smaller in the difficult ureter group than in the nondifficult ureter group (8.8 ± 3.9 mm vs. 10.9 ± 4.5 mm, <i>P</i> < 0.018). A major axis <8 mm (odds ratio: 4.495, 95% confidence interval: 1.791-11.278, and <i>P</i>=0.001), negative traceability (odds ratio: 7.565, 95% confidence interval: 2.693-21.248, and <i>P</i> < 0.001), smoking status (odds ratio: 3.196, 95% confidence interval: 1.164-8.773, and <i>P</i>=0.024), and absence of diabetes mellitus (odds ratio: 5.813, 95% confidence interval: 1.121-30.142, and <i>P</i>=0.036) were identified as independent predictors of difficult ureters on multivariate logistic regression analysis.</p><p><strong>Conclusion: </strong>Patients with smaller stones, negative traceability, ongoing tobacco consumption, and absence of diabetes mellitus were at higher risk of difficult ureters. In these patients, preoperative stenting may be considered.</p>\",\"PeriodicalId\":45110,\"journal\":{\"name\":\"Minimally Invasive Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911238/pdf/\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minimally Invasive Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2023/2584499\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minimally Invasive Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2023/2584499","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 1
摘要
目的:探讨输尿管镜碎石术中输尿管困难的危险因素,确定术前支架置入术的适应证。方法:我们回顾性分析156例输尿管镜下治疗上尿路结石的手术,排除术前支架置入或经皮肾造口术。输尿管的可追溯性由两名泌尿科医生评估。如果泌尿科医生中的一方或双方在术前计算机断层扫描的所有切片中识别出输尿管,则可追溯性被定义为阳性。比较非输尿管困难组和输尿管困难组患者的背景。采用多因素logistic回归模型评价输尿管困难与其他临床因素的关系。结果156例患者中,输尿管困难组31例(19.9%)。非输尿管困难组的阳性溯源性更高(48.3%比83.2%,P < 0.001)。输尿管困难组的输尿管长轴较非输尿管困难组小(8.8±3.9 mm比10.9±4.5 mm, P < 0.018)。多因素logistic回归分析发现,输尿管困难的独立预测因素为:主轴P=0.001)、阴性溯源性(比值比:7.565,95%可信区间:2.693 ~ 21.248,P < 0.001)、吸烟(比值比:3.196,95%可信区间:1.164 ~ 8.773,P=0.024)、无糖尿病(比值比:5.813,95%可信区间:1.121 ~ 30.142,P=0.036)。结论:结石较小、可追溯性阴性、有吸烟史、无糖尿病的患者发生输尿管困难的风险较高。在这些患者中,可以考虑术前支架置入术。
Clinical Factors to Predict Difficult Ureter during Ureteroscopic Lithotripsy.
Objective: To identify risk factors for difficult ureters during ureteroscopic lithotripsy and to determine the appropriate indications for preoperative stenting.
Methods: We retrospectively analyzed 156 ureteroscopic procedures for upper urinary tract stones after excluding those with preoperative stenting or percutaneous nephrostomy. Traceability of the ureter was assessed by two urologists. Traceability was defined as positive if either or both urologists discerned the ureter in all slices on preoperative plain computed tomography. Patients' backgrounds were compared between the nondifficult ureter and difficult ureter groups. A multivariate logistic regression model was used to evaluate the relationships between difficult ureters and other clinical factors.
Results: Of 156 patients, 31 (19.9%) were classified into the difficult ureter group. The positive traceability was higher in the nondifficult ureter group (48.3% vs. 83.2%, P < 0.001). The major axis was smaller in the difficult ureter group than in the nondifficult ureter group (8.8 ± 3.9 mm vs. 10.9 ± 4.5 mm, P < 0.018). A major axis <8 mm (odds ratio: 4.495, 95% confidence interval: 1.791-11.278, and P=0.001), negative traceability (odds ratio: 7.565, 95% confidence interval: 2.693-21.248, and P < 0.001), smoking status (odds ratio: 3.196, 95% confidence interval: 1.164-8.773, and P=0.024), and absence of diabetes mellitus (odds ratio: 5.813, 95% confidence interval: 1.121-30.142, and P=0.036) were identified as independent predictors of difficult ureters on multivariate logistic regression analysis.
Conclusion: Patients with smaller stones, negative traceability, ongoing tobacco consumption, and absence of diabetes mellitus were at higher risk of difficult ureters. In these patients, preoperative stenting may be considered.