Investigation of ureteral stricture in patients with ureteral calculi after pneumatic ballistic lithotripsy and its influence on prognosis / 国际外科学杂志

ABSTRACT

Objective:To investigate the occurrence of ureteral stricture in patients with ureteral calculi after pneumatic ballistic lithotripsy and its influence on the prognosis of patients.Methods:Using retrospective study method, 42 patients with ureteral calculi who underwent pneumatic ballistic lithotripsy in the Eighth Hospital of Wuhan from August 2018 to August 2020 and developed ureteral stricture were included in the stricture group, 60 patients with ureteral calculi who received the same surgical treatment in the Eighth Hospital of Wuhan without postoperative ureteral stricture were regarded as the non-stricture group. The general data, recurrence at 6 months and 1 year after operation and quality of life score at 1 year after operation were compared between the two groups. The measurement data were expressed by mean ±standard deviation ( ± s), independent sample t-test was used for inter-group comparison, and Chi-square test was used for inter-group comparison of counting data. Univariate and multivariate Logistic regression analysis were used to evaluate the risk factors of ureteral stricture in patients with ureteral calculi after pneumatic ballistic lithotripsy, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the influencing factors on postoperative ureteral stricture. Results:The results of univariate analysis showed that the proportion of patients with disease course ≥ 3 months, maximum diameter of stones > 2 cm, multiple stones, incarcerated stones and inflammatory mucosa-wrapped stones in the stricture group were significantly higher than those in the non-stricture group ( P<0.05). Multivariate Logistic regression analysis showed that the course of disease ≥ 3 months, the maximum diameter of stones > 2 cm, multiple stones, incarcerated stones and inflammatory mucosa-wrapped stones were all risk factors for postoperative ureteral stricture ( P<0.05). The area under the ROC curve of each factor predicting postoperative ureteral stricture were 0.685 (95% CI 0.602-0.768), 0.743 (95% CI 0.685-0.801), 0.812 (95% CI 0.749-0.875), 0.853 (95% CI 0.801-0.905), 0.726 (95% CI 0.673-0.779), all have high predictive value ( P<0.001). The recurrence rate at 6 months after operation in the stricture group [16.67% (7/42)] and the total recurrence rate [23.81% (10/42)] were significantly higher than those in the non-stricture group [3.33% (2/60), 8.33% (5/60)], the differences were statistically significant ( P<0.05). One year after operation, the physiological function (67.42±9.64), physiological function (71.35±10.16) and overall health score (73.49±10.31) were significantly lower than those in the non-stricture group (76.39±9.42, 75.34±9.26, 79.86±10.24), the differences were statistically significant ( P<0.05). Conclusion:The occurrence of ureteral stricture after pneumatic ballistic lithotripsy increases the risk of recurrence in patients with ureteral stones. Identifying the risk factors that affect patients with ureteral stricture after surgery is conducive to timely and effective intervention measures to improve the prognosis and quality of life of patients.