Category: Clinical Stones: Ureteroscopy
Introduction & Objective :
It is generally advised to keep a safety guidewire (SGW) in the ureter during endoscopy of the upper urinary tract, but in the era with miniaturization of ureteroscope, there is a lack of high leveled evidences to confirm efficacy and safety of SGW. The purpose of this study was to investigate whether not-using SGW is efficient and safe?
In a 2-year period (2016–2018), 310 patients admitted to Shahid Labbafinejad University Hospital for endoscopic treatment of ureteral stone were randomly assigned in using-SGW (group1) and non-using-SGW (group2) ureteroscopy, which 153 patients in group 1 and 147 patients in group 2 were followed until the end of the study. Pre-operative data (age, gender, BMI, creatinine, stone location, stone surface size, pain severity), Peri-operative data (number of try, success rate of ureteral entry, success rate of stone access, stone migration rate, success rate of ureteral stent insertion, severity of injury, operative time, conversion to open surgery); 2 weeks and 3 months’ post-operative data (Treatment success rate, pain severity, and exist of hydronephrosis) were evaluated between both groups<./p>
Pre-operative data in using SGW and non-using SGW were non-significantly different between two groups (age: 43.64±12.66 vs. 41.99±11.73; P: 0.24; BMI: 28.2±10.1 vs. 26.3±9.3; P: 0.34; Stone surface size: surface size was 63.12±9.12 and 56.14±9.43 mm3, P:0.36; pain severity: 1.91±1.06 vs. 2.09±1.03, P: 0.37; creatinine: 1.39±1.10 vs. 1.44±1.90, P: 0.77 and location of stone, P:0.25). Peri and post-operative outcomes including: number of try (P:0.34), success rate of ureteral entry (P:0.62), success rate of stone achievement (P:0.78), stone migration rate (P:0.13), success rate of ureteral stent insertion (P:0.99), severity of injury (P:0.18), operative time (P:0.65), 2 weeks and 3-month treatment success rate (P:0.24, P:0.75), pain severity (P:0.64, P:0.38) and exist of hydronephrosis (P:0.58, P:0.79) were non-significance different between both groups. When we subgroup analyzed the data in proximal ureteral stones, the analysis showed higher rate of injuries in using-SGW group vs. non-SGW groups (P: 0.03).
Using small sized semi-rigid ureteroscope, it seems thatnon-using SGW has not inferior outcomes compared with using-SGW in treatment of ureteral stones. On the other hand, for proximal ureteral stones, it seems that non-using SGW had lower injury rate compared to using-SGW.
Abbas Basiri– Tehran, Tehran, Iran
Ali Zare– Tehran, Tehran, Iran
Hamidreza Shemshaki– Tehran, Tehran, Iran
Akbar Nouralizadeh– Tehran, Tehran, Iran
Farzaneh Sharifi aghdas– tehran, Tehran, Iran
Mohammad Hadi Radfar– tehran, Tehran, Iran
Nasser Shakhse Salim– Tehran, Tehran, Iran