Intraoperative Komplikationen bei der ureterorenoskopischen Steintherapie in Abhängigkeit eines Pre-Stenting

Hintergrund, Ziele und Methode: Das Harnsteinleiden stellt ein Krankheitsbild mit steigender Inzidenz dar, das bei einer Harnleiterpassage des Steins durch kolikartige Schmerzen zu häufiger Hospitalisierung mit Bedarf einer interventionellen Maßnahme führt. Hierbei steht unter anderem die Ureteroren...

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Bibliographic Details
Main Author: Boneberg, Aline
Contributors: Huber, J. (Prof. Dr. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2022
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Background, aims and methods: Urolithiasis and nephrolithiasis are clinical pictures with increasing incidence, which lead to frequent hospitalization requiring interventional measures due to colicky pain, associated with an obstruction of the ureter. Ureterorenoscopy is available as a standard treatment, which can however be associated with intraoperative complications despite high clinical safety. These include minor intraoperative complications such as perforation of the ureter, injury of the ureteral mucosa followed by bleeding as well as major complications such as a rupture or invagination of the ureter. Previous studies have addressed the question as to how the preoperative insertion of a ureteral stent affects various criteria including intraoperative complications. However, these studies show a heterogeneous picture. In this context the question arises as to what extent preoperative stenting provides a benefit for the outcome of the ureterorenoscopy. In the present work, this is retrospectively analyzed in more detail with the help of patient data. For the study patients presenting to the clinic for urology and pediatric urology of the University Hospital Gießen and Marburg (Marburg site) in the period between 1 January 2014 and 31 December 2014 with a urinary stone were selected. In order to improve the informative value of the data for the present study the patients were divided into two large groups. In order to be able to work on the main topic of this work more precisely the patients were divided into two large groups. The first group received pre-stenting before the endoscopic intervention (90 cases) whereas the second group did not receive a ureteral stent before the ureterorenoscopy (57 cases). Results: The results of this study show both positive and negative effects of pre-stenting before a planned ureterorenoscopy. For example, a significant decrease in the number of patients with haematuria and renal pelvic ectasia was observed in patients with pre-stenting. Pre-stenting also reduces the fraction of patients with colicky symptoms. Furthermore, the application of a ureteral stent leads to a significant reduction in the intake of spasm analgesics such as metamizole and alpha-receptor blockers (tamsulosin) during the inpatient stay. Positive effects, such as the significant reduction in bougienage of the urinary tract in patients with pre-stenting can also be observed during the intraoperative course. On the other hand intraoperative complications are significantly more common in the pre-stented group. A significant difference can be seen concerning especially ureter lesions and intraoperative bleeding. The proportion of detection of various germs in the urine during hospital admission is also significantly higher in patients with a ureteral stent. Discussion and conclusions: The main question addressed in this study is how pre-stenting affects intraoperative complications of ureterorenoscopy. It should be noted that intraoperative complications were only rarely observed in this study, but almost exclusively in the group with pre-stenting. According to the results of this work, the placement of a ureteral stent before the planned ureterorenoscopy can potentially lead to an improvement in the surgical conditions. There is a reduction in the rate of urinary tract bulging and a decrease in the fraction of impacted stones. In addition, a flexible ureteral scope can be used more frequently in patients with pre-stenting. This is also confirmed by a comparable study (Navetta et al. 2019). However, another study shows no significant improvement regarding the complication rate by pre-stenting regardless of the location or stone size (Dessyn et al. 2016). However, another study shows no significant improvement for pre-stenting regardless of the location or stone size with regard to the complication rate (Dessyn et al. 2016). In summary, it can therefore be stated that despite the positive effects of pre-stenting, increased intraoperative complications imply that the indication for the insertion of a ureteral stent before an ureterorenoscopy should only be made according to the specifications of the cor-responding guideline. For this reason exceptions require a careful risk assessment in the interest of the patient.