The association between ureteral wall thickness and need for additional procedures after primary ureteroscopy in patients with ureteral stones above the iliac crest

Abstract

Purpose To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level.

Methods Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018–2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures.

Results The median patient age was 51 years [interquartile range (IQR): 18–66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1–11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3–6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm.

Conclusion Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.

Zusammenfassung

Zweck Untersuchung der Parameter, die die Notwendigkeit zusätzlicher Eingriffe der primären Ureteroskopie-Behandlung bei Patienten mit Harnleitersteinen oberhalb des Beckenkamms beeinflussen.

Methoden Einundsiebzig Patienten, die ≥ 18 Jahre alt waren und sich zwischen 2018 und 2020 einer Ureteroskopie (URS) wegen Harnleitersteinen oberhalb des Beckenkamms unterzogen und eine nicht kontrastverstärkte abdominale Computertomographie hatten, bevor die Verfahren in die Studie aufgenommen wurden. Patienten und Steinmerkmale wurden prospektiv erhoben. Die Ergebnisse wurden sechs Wochen nach URS ausgewertet. Es wurde angenommen, dass das Fehlen jeglicher Restfragmente auf einen steinfreien Status hinweist. Die Patienten mit Misserfolg wurden auf die zusätzlichen Verfahren verwiesen.

Ergebnisse Das mediane Patientenalter betrug 51 Jahre [Interquartilbereich (IQR): 18–66]. Der mediane transversale Steindurchmesser betrug 9,5 mm (IQR: 7,1–11,4) und die mediane Ureterwanddicke (UWT) betrug 5,8 mm (IQR: 4,3–6,5). In der univariaten Analyse beeinflussten UWT (p < 0,001), das Vorhandensein mehrerer Steine (p = 0,008) und die Steinlänge (p=0,022) den steinfreien Status. Die multivariate Analyse ergab, dass UWT der einzige unabhängige Faktor ist, der die Notwendigkeit zusätzlicher Verfahren nach URS beeinflusst (p = 0,028). In der Receiver-Betriebskennlinienanalyse wurde der gemäß den Ergebnissen beste Schwellwert für UWT mit 5,8 mm ermittelt.

Schlussfolgerung Die Harnleiterwanddicke war der einzige unabhängige Parameter, der die Notwendigkeit zusätzlicher Verfahren bestimmte und die Behandlungsergebnisse nach dem URS-Verfahren beeinflusste.

Schlüsselwörter

Harnleiterstein - Ureteroskopie - Minimalinvasive Chirurgie - Nicht kontrastverstärkte Computertomographie - Behandlungsergebnis

Keywords

Ureteral stone - Ureteroscopy - Minimally invasive surgery - Treatment outcome - Non-contrast enhanced computed tomography

Publikationsverlauf

Eingereicht: 28. April 2022

Angenommen nach Revision: 21. Juli 2022

Artikel online veröffentlicht:
06. Dezember 2022

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