动态肾脏扫描作为柔性输尿管镜检查的一种随访方式。

IF 1.4 Q3 UROLOGY & NEPHROLOGY Archivio Italiano di Urologia e Andrologia Pub Date : 2024-05-13 DOI:10.4081/aiua.2024.12393
Murad Asali, Osman Hallak
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引用次数: 0

摘要

目的确定在柔性输尿管镜检查(f-URS)后常规进行的动态肾脏扫描--DTPA或MAG3--是否能发现梗阻的发展,从而促进及时的早期干预以保护肾脏:在这项回顾性研究中,2010 年 4 月至 2023 年 10 月期间的所有数据均被前瞻性记录在案,对同一医疗中心的一名外科医生为 242 名接受输尿管镜检查的上尿路结石(UUTS)患者的 250 个肾单位进行了评估。无结石率(SFR)是指通过术中 "三重检验 "确定无残余碎片。对以下特征进行了研究:性别、体重指数、年龄、Hounsfield单位、结石直径、侧位、肾/输尿管结石、无结石率以及每个肾单位的辅助手术。报告并发症时使用了克拉维恩-丁多分类法。有残余结石的肾单位被安排进行第二次输尿管软镜检查。柔性输尿管镜检查后,使用肾脏扫描 DTPA 或 MAG-3 检测输尿管梗阻和肾功能。主要结果是肾/输尿管梗阻:患者平均年龄为 53 岁。结果:患者平均年龄为 53 岁,结石平均大小为 12.3 毫米。9.2%(23 例)、27.6%(69 例)和 30.8%(77 例)的病例治疗了肾盂、肾上盏、肾中盏和肾下盏的结石;44%(110 例)的输尿管结石也得到了治疗。单次和第二次手术的SFR分别为94.8%和99.7%。有一个肾单位(0.4%)需要进行第三次辅助手术。每个肾单位的平均手术次数为 1.06 次(264/250)。53.6%的病例(134 例)植入了输尿管双 J 支架。37例(14.8%)在手术前放置了支架。术后并发症较少,仅有两名患者(0.8%)需要再次入院并控制疼痛。没有发现输尿管撕裂或穿孔。六名患者的t1/2在10-20分钟之间,第二次肾脏扫描显示,五名患者的病情自发好转,没有出现梗阻。一名患有大结石并曾接受过输尿管镜检查的患者出现了输尿管狭窄(0.4%),需要进行激光输尿管内切开术治疗:结论:输尿管狭窄导致的输尿管镜检查后梗阻非常罕见。结论:输尿管软镜术后因输尿管狭窄导致梗阻的情况非常罕见。术后常规肾脏扫描可用于潜在的高风险患者。
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Dynamic renal scans as a modality for follow-up of flexible ureteroscopy.

Objective: To determine whether dynamic renal scans - DTPA or MAG3 - routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation.

Patients and methods: In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative "triple test". The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction.

Results: The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy.

Conclusions: Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

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35.70%
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