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Selective postoperative imaging after ureteroscopy.

机译:输尿管镜检查后的选择性术后影像学检查。

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OBJECTIVES: To evaluate the need of routine follow-up imaging after ureteroscopy. METHODS: We performed a retrospective chart review of patients undergoing ureteroscopy for urolithiasis. Selective imaging was performed in the initial postoperative phase (1-3 weeks after removal of the ureteral stent) if the procedure was classified as complicated because of the presence of an impacted stone, the need for balloon dilation, intraoperative ureteral perforation, or postoperative pain after stent removal. Uncomplicated ureteroscopy was followed by repeat imaging if the patient developed recurrent renal colic or as surveillance for new stone growth at 6-12 months of follow-up. RESULTS: A total of 267 ureteroscopic procedures were performed on 253 patients. The data from 214 of 253 patients (84.6%) who had undergone noncontrast-enhanced computed tomography imaging > or = 1 month after surgery were analyzed. The mean follow-up was 14.5 months (range 1-66). The incidence of stricture was 1.4% (3/214). The incidence in the selective imaging (complicated ureteroscopy) group was 5.3% (3/56). In uncomplicated ureteroscopy group, it was 0% (0/158). Ureteral stricture developed in 3 of 11 patients with stone impaction (27.2%, P = .002), 2 of 14 patients undergoing ureteral balloon dilation (10.4%, P = .0052), and in 1 of 6 patients with an intraoperative mucosal perforation (16.6%, P = .0326). Persistent postoperative pain after stent removal was not predictive of stricture formation (3.6%, P = .139). CONCLUSIONS: The results of our study have shown that selective imaging as determined by the intraoperative findings of complicated ureteroscopy (eg, impacted stone, balloon dilation, mucosal perforation) will detect postoperative ureteral strictures. Routine follow-up imaging is not essential after uncomplicated ureteroscopy.
机译:目的:评估输尿管镜检查后常规随访成像的必要性。方法:我们对接受输尿管镜检查尿路结石的患者进行了回顾性图表回顾。如果由于结石受累,需要球囊扩张,术中输尿管穿孔或术后疼痛而被归类为复杂手术,则在术后初始阶段(移除输尿管支架后1-3周)进行选择性成像取出支架后。如果患者出现复发性肾绞痛或在随访6-12个月时监测新的结石生长,则需进行简单的输尿管镜检查,然后重复成像。结果:共对253例患者进行了267例输尿管镜检查。分析了253例患者中214例(84.6%)的患者在手术后1个月或以上接受了无对比增强X线断层显像的数据。平均随访14.5个月(范围1-66)。狭窄的发生率为1.4%(3/214)。选择性成像(复杂的输尿管镜)组的发生率为5.3%(3/56)。单纯输尿管镜检查组为0%(0/158)。 11例石块撞击患者中有3例发生输尿管狭窄(27.2%,P = .002),14例接受输尿管球囊扩张的患者中有2例(10.4%,P = .0052),术中有粘膜穿孔的6例患者中有1例(16.6%,P = .0326)。移除支架后持续的术后疼痛不能预示狭窄的形成(3.6%,P = .139)。结论:我们的研究结果表明,根据复杂输尿管镜术中发现的结果(例如,受累结石,球囊扩张,粘膜穿孔)确定的选择性成像将可以检测出术后输尿管狭窄。简便的输尿管镜检查后,常规的随访成像不是必需的。

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