Risk factors of ureteral stricture after ureteroscopic holmium laser lithotripsy / 国际外科学杂志

ABSTRACT

Objective:To investigate the ureteral stricture after ureteroscopic holmium laser lithotripsy in patients with ureteral calculi and its effect on prognosis.Methods:The clinical data of 406 patients who underwent ureteroscopic holmium laser lithotripsy in Nanjing Tongren Hospital from January 2018 to August 2019 were analyzed retrospectively, according to postoperative ureteral stricture, the patients were divided into stricture group ( n=28) and non-stricture group ( n=378). The independent risk factors of postoperative ureteral stricture in patients with ureteral calculi were evaluated by univariate and multivariate Logistic regression analysis, and the postoperative recurrence rate and prognosis of the two groups were compared.The nomogram model was constructed according to independent risk factors, and the accuracy of the model was verified by receiver operating characteristic (ROC) curve, GiViTI calibration band and clinical decision curve. Measurement data were expressed as mean±standard deviation ( ± s), comparison between groups used t-test, and comparison of count data between groups used Chi-square. Results:Univariate analysis showed that there were significant differences in course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone, ureteral injury and operation time between non-stricture group and stricture group ( P<0.05). Multivariate Logistic regression analysis showed that the course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone and ureteral injury were independent risk factors for postoperative ureteral stricture in patients with ureteral calculi ( P<0.05). The patients with ureteral calculi were followed up for 1 year by telephone, outpatient reexamination and medical record inquiry. During the follow-up period, 106 cases of ureteral calculi recurred. The recurrence rate of 1 year (21.43% vs 8.99%) and 2 years (35.71% vs 14.81%) in the stricture group was significantly higher than that in the non-stricture group, the differences were statistically significant ( χ2=4.54, 8.36, P<0.05). Compared with the non-stricture group, the physiological function score [(79.28±8.17) vs (65.22±10.53)], physiological function score [(78.54±9.33) vs (69.23±7.86)] and overall health score [(81.03±10.54) vs (70.43±7.38)] in the stricture group were significantly lower, the differences were statistically significant ( t=7.70, 5.29, 5.43, P<0.05). The area under curve of the constructed nomogram model ROC curve was 0.882 (95% CI 0.774-0.928). In the 80%-90% confidence interval area of the GiViTI calibration curve belt, it does not pass through the 45° angle bisector ( P=0.176). The clinical decision curve indicates that the net benefit rate was high. Conclusions:The course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone and ureteral injury are independent risk factors for postoperative ureteral stricture in patients with ureteral calculi. Clinicians should actively take intervention measures to reduce the incidence of postoperative ureteral stenosis, improve the prognosis and improve the quality of life of patients.