接受輸尿管鏡碎石術之病人其三日內再回診之病例分析:中榮經驗報告
謝享宸、裘坤元
台中榮民總醫院 外科部 泌尿外科
Patients who undergo ureteroscopic lithotripsy returned within three days after discharge : the experience of VGHTC
Hsiang-Chen Hsieh, Kun-Yuan Chiu
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Introduction:
To define incidence of 3-days returning to emergency department (ED) after discharge in patients undergoing ureteroscopic lithotripsy (URSL), and describe its stone, radiological features and presenting symptoms. Our objective is to be able to identify possible predisposing or predictor factors.
Patients and methods:
We retrospectively reviewed the records of 1937 URSLs performed from Mayday 2014 to August 2018, and identified 59 patients (3.04%, mean age 58.8 years; 17 women and 42 men) returning to ED within three days after discharge. The patients’ stone and radiological features were studied, and the postoperative outcome and patient characterization were analyzed.
Results:
About patient characterization, 29 patients (49.2%) had history of previous urolithiasis, 11 with diabetes mellitus and 22 with hypertension.
The sites of ureter stones at upper, middle and lower were 34 (57.6%), 9 (15.3%) and 16 (27.1%) respectively. The locations of ureter stone were 36 in right side (61%), 21 in left side (36%) and 2 in bilateral side (3%). The mean size of ureter stones was 0.846 cm. We divide the size of the ureter stone into three groups, large (>1.0cm, 4, 6.8%), medium (1.0-0.4cm, 36, 61%) and small (<0.4cm, 19, 32.2%) separately.
The mean days of return after discharge was 1.47 (0-3) days. Fever was commonest symptoms of presentation (33, 55.9%) followed by hematuria (14, 23.7%), others included abdominal pain (4), AUR (2) and new event (6). The new events were all not associated with the procedure and hospital course included tarry stool due to esophageal variceal bleeding and GI tract ulcer, new onset stoke, acute on chronic headache and generalized urticaria.
Pyuria was present in 28 patients (47.5%) and urine culture reported significant growth in 19 patients (32.3%), in which 16 was Pseudomonas aeruginosa. 5 patient with pyuria received removal of double-J catheter. In addition, four patient developed sepsis, who had significant finding on blood culture.
Conclusion:
History of previous urolithiasis, stone of upper third ureter seem to be possible predisposing and predictor factors. Patient with fever presented pyuria was 26 (78.8% in fever group), and could be considered meaningful clue that patient with pyuira found when first hospital course should be more aggressive to prove antibiotic treatment and even longer hospital stay. Nevertheless, further studies are required.