Podium 1
椎弓螺釘置放與輸尿管狹窄風險之相關性：單一醫學中心回溯性世代研究
蕭伯任1、宋文瑋1,2,3、楊旻鑫1,2,3、謝佐宜1,2,3、陳文榮1,2,3、陳順郎1,2,3、王紹全1,2,3
1中山醫學大學附設醫院泌尿科；2中山醫學大學醫學院；3中山醫學大學醫學研究所
The Relationship between the Placement of Pedicle Screws and the Risk of Ureteral Stricture: A Retrospective Single-center Cohort Study
Po-Ren, Hsiao1、Wen-Wei, Sung1,2,3、Min-Hsin, Yang1,2,3、Tzuo-Yi, Hsieh1,2,3、Wen-Jung, Chen1,2,3、Sung-Lang, Chen1,2,3、Shao-Chuan, Wang1,2,3
1Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; 2School of Medicine and 3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Purpose:
There were few reports concerning ureteral injuries during spine surgeries. Considering the anatomic accessibility of posterior spine and ureters, the risk of ureteral injuries was supposed to be higher in spine surgeries. Pedicle Screws implantation used in spinal fusion surgeries may put ureters in jeopardy, resulting urinary tract leakage or ureteral strictures. We aimed at investigating the relationship between the placement of pedicle screws and the risk of ureteral stricture.
Materials and Methods:
We retrospectively screened patients undergoing ureteroscopy (URS) surgeries from Jan 1, 2010 to Dec 31, 2022 at Chung Shan Medical University Hospital in Taichung, Taiwan. Data on patient demographics and intraoperative findings were collected. Among the cohort, patients who had the placement of pedicle screws before URS were compared with those who had no placement. The outcome was ureteral stricture and related hydronephrosis according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Cox regression model was used to evaluated the risk of ureteral strictures.
Results:
A total of 7,179 patients were enrolled in this study. 41 (0.57%) patients had the placement of pedicle screw. Six (14.63%) patients in the group of patients with pedicle screws were reported to have ureteral stricture. The risk of ureteral stricture was non-significantly observed in the group of patients with pedicle screws. (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.29-1.45, p-value=0.29)
Conclusions:
Ureteral injury is a rare complication and is easily missed. The anatomic relationship between the ureter and pedicle screws is not compatible with the study result, probably because of low incidence and great disparity of patient numbers. Ureteral stricture is also contentious in the definition, causes and diagnostic methods. Further researches are needed to define ureteral stricture through intravenous pyelography (IVP), computed tomography (CT) with contrast medium or other image studies. Overall, early diagnosis is critical for the prognosis of complications associated with iatrogenic ureteral injury.