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尿道缩发生后的跨壁尿道镜尿道损伤:一个以前未经证实的担忧
Andrei D Cumpanas1, Seyed Amiryaghoub M Lavasani1, Jaime Altamirano-Villarroel1
1Department of Urology, University of California, Irvine, Orange, California, USA.
Journal of endourology
|June 9, 2025
概括
在尿路透镜检查 (URS) 后,尿道狭窄的风险会随着尿道损伤的深度显著增加. 一个新的简化评分系统可以帮助识别高风险患者,以便更好地预测预后.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 外科手术的结果
- 医疗器械技术 医疗器械技术
背景情况:
- 尿道狭窄是尿道透视术 (URS) 后的潜在并发症.
- 在URS后尿管狭窄的发病率通常报告为低,从0.3%到3%.
- 尿管损伤的深度可能会影响发展狭窄的风险.
研究的目的:
- 为了调查尿道损伤的深度之间的关系,通过后尿道镜损伤量表 (PULS) 评估,和de novo尿道狭窄的发生率.
- 开发一种简化的分级系统,用于预测尿管收缩后尿管收缩的形成.
主要方法:
- 在2018年至2022年期间,对550名接受URS治疗的患者进行了回顾性分析,这些患者因上道结石而接受了URS治疗.
- 患者使用后尿道镜损伤量表 (PULS) 进行评估,并随访3-6个月,进行成像.
- 排除标准包括先前存在的狭窄或在狭窄部位受到影响的石头.
主要成果:
- 总体de novo狭窄率为0.73% (4/550),随访时间中位数为23个月.
- 在PULS等级0 (0%) 和1 (0.48%) 中,缩率最低.
- 缩率在PULS 2级增加到1.1%,在PULS 3级 (跨壁伤害) 增加到13.3%.
- 尿路细胞分裂 (PULS ≥2) 和外壁损伤 (PULS 3) 显著增加了狭窄发展的几率 (分别是13倍和40倍).
结论:
- 随着尿路壁的完整性受到损害,Iatrogenic尿路收缩率急剧上升.
- 隔壁损伤 (PULS 3) 与高收缩率 (13.3%) 相关.
- 一个简化的两阶段评分系统 (加利福尼亚大学,欧文[UCI]0,1或2) 可以有效地识别患有后URS狭窄形成高风险的患者.
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