Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation?

Abstract

Purpose To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones.

Methods This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success.

Results There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively).

Conclusion Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

Zusammenfassung

Einführung Untersuchung des Zusammenhangs zwischen Versagen des Vorschiebens einer Harnleiterschleuse (HLS) und entzündlichen Prozessen sowie anderen klinischen Parametern bei Patienten, die wegen Nierensteinen mit flexibler Ureteroskopie behandelt wurden.

Methoden Zielgruppe dieser Studie waren Patienten, die zwischen 2015 und 2020 in unserem Zentrum durch flexible Ureterorenoskopie operiert wurden. Patienten, bei denen ein chirurgischer Eingriff in den ipsilateralen Harnleiter durchgeführt wurde und in der Vergangenheit eine spontane Steinpassage aufgetreten war, wurden ausgeschlossen. Die Patienten wurden je nach Erfolg (Gruppe 1) oder Misserfolg (Gruppe 2) des HLS-Vorschiebens in 2 Gruppen eingeteilt. Es erfolgte ein Vergleich beider Gruppen hinsichtlich klinischer Merkmale sowie präoperativer Neutrophilen-, Lymphozyten-, Monozyten- und Thrombozytenzahlen und der Verhältnisse dieser Zahlen, die alle als Entzündungsmarker angesehen wurden. Eine multivariate logistische Regressionsanalyse wurde durchgeführt, um die unabhängigen Variablen zu bestimmen, die den Erfolg des HLS-Vorschiebens beeinflussen.

Ergebnisse Gruppe 1 bestand aus 113 (59,1 %) Patienten, Gruppe 2 aus 78 (40,9 %) Patienten. Gruppe 2 wies signifikant höhere Raten von Patienten männlichen Geschlechts, koronarer Herzkrankheit und präoperativer ipsilateraler Hydronephrose auf, während die Thrombozytenzahlen und Thrombozyten-Lymphozyten-Verhältnisse in Gruppe 2 signifikant niedriger waren. Unsere Analyse ergab vier unabhängige Prädiktoren für ein Versagen des HLS-Vorschiebens: Das weibliche Geschlecht (Odds Ratio [OR] = 2,1) erhöhte die Erfolgsrate des Einführens der HLS, während Hydronephrose (OR = 1,6), niedrige Thrombozytenzahlen und PLR die Versagensrate beim Einführen der HLS erhöhten (OR = 0,99 bzw. OR = 0,98).

Schlussfolgerungen Unsere Ergebnisse legen nahe, dass männliches Geschlecht und ipsilaterale Hydronephrose mit einem erhöhten Versagen des Einführens einer HLS verbunden sind. Obwohl wir einen Zusammenhang zwischen relativ niedrigen Thrombozytenwerten und HLS-Insertionsversagen nachweisen konnten, sind wir der Ansicht, dass weitere Studien zu diesem Thema erforderlich sind.

Schlüsselwörter

Entzündung - Thrombozyten - Ureterorenoskopie - Ureteroskopie - Ureterzugangsschleuse

Keywords

inflammation - platelets - ureteral access sheath - ureteroscopy - ureterorenoscopy

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