以門診手術為單一輸尿管結石病患進行內視鏡雷射碎石手術能得到良好的臨床預後
侯鎮邦、林友翔、張慧朗、陳建綸、楊珮珊、崔克宏
長庚醫療財團法人林口長庚紀念醫院 泌尿外科
Outpatient Ureteroscopic Holmiun Laser Lithotripsy Achieves Favorable Outcomes in Patients with Single Ureteral Stone
Chen-Pang Hou, Yu-Hsiang Lin, Phei-Lang Chang, Chien-Lun Chen, Pei-Shan Yang, Ke-Hung Tsui.
Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Purpose: To evaluate the surgical outcomes of patients with single ureteral stones who underwent outpatient ureteroscopic Holmium laser lithotripsy and compare the outcomes with those who received the same procedures in an inpatient fashion.
Materials and Methods: The records were obtained during January 2012 to December 2016 for selected patients underwent ureteroscopic Holmium laser lithotripsy in our institution. The patients were excluded if their ECOG performance status were >1, presenting with multiple stones or concomitant renal stones, having cancer history or congenital urinary system abnormality. Those who had undergone urinary system reconstruction surgery were also excluded. The patients were able to decide to receive the procedure with an outpatient or an inpatient fashion. All the surgeries were carried out by a single surgeon. Their preoperative, operative and postoperative data were recorded. The clinical results such as urinary tract infection, anodyne requirement, the rate of returning to the emergent room, stone clearance, surgical complications, and the medical expenditure for the treatment courses were analyzed and compared between the two cohorts.
Results: A total of 303 patients met the including criteria. Among them, 119 patients decided to receive outpatient ureteroscopic laser lithotripsy while 184 decided to receive the procedure in an inpatient fashion. The outpatient cohorts were younger in age (p<0.001), having smaller stone diameters (p<0.001) and fewer comorbidity factors (p=0.038). The patients who had previous stone manipulation history were more favor choosing to receive the procedure under admission (p<0.001). There were no significant differences between the two cohorts in regards to operative time, rates of failure to lithotripsy and the operative complications. The rates of stone clearances, post-op UTI, anodyne requirement, and the rate of returning to the emergent room were also comparable between the two groups. However, the medical expenditure was significantly lower in the outpatient cohort (p<0.001).
Conclusions: Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economic compared to the inpatient group and achieved favorable outcomes for patients with single ureter stone.