Clinical determination of the natural distensibility of the human ureter: initial study.

Autor: Ali SN; Department of Urology, University of California, Irvine, Orange, CA, USA., McCormac A; Department of Urology, University of California, Irvine, Orange, CA, USA., Cumpanas AD; Department of Urology, University of California, Irvine, Orange, CA, USA., Altamirano-Villarroel J; Department of Urology, University of California, Irvine, Orange, CA, USA., Piedras P; Department of Urology, University of California, Irvine, Orange, CA, USA., Vu MC; Department of Urology, University of California, Irvine, Orange, CA, USA., Afyouni AS; Department of Urology, University of California, Irvine, Orange, CA, USA., Tano ZE; Department of Urology, University of California, Irvine, Orange, CA, USA., Osann K; Department of Medicine and Program in Public Health, University of California, Irvine, Orange, CA, USA., Klopfer M; Henry Samueli School of Engineering, University of California, Irvine, Orange, CA, USA., Jiang P; Department of Urology, University of California, Irvine, Orange, CA, USA., Patel RM; Department of Urology, University of California, Irvine, Orange, CA, USA., Landman J; Department of Urology, University of California, Irvine, Orange, CA, USA., Clayman RV; Department of Urology, University of California, Irvine, Orange, CA, USA.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Oct 26. Date of Electronic Publication: 2024 Oct 26.
DOI: 10.1111/bju.16564
Abstrakt: Objectives: To define the natural distensibility of the human ureter and evaluate the impact of other possibly favourable factors on ureteric distensibility.
Patients and Methods: A total of 101 patients undergoing ureteroscopic stone removal or percutaneous nephrolithotomy underwent ureteric sizing using sequential passage of 37-cm urethral dilators in 2-F increments while attached to a unique force sensor. Insertion forces were limited to 6 N. After 6 N was attained, an appropriately sized ureteric access sheath was passed. At the conclusion of each procedure, Post-Ureteroscopic Lesion Scale score was determined.
Results: Urethral dilators were passed in 61% of patients at ≤14 F; 39% of patients accepted urethral dilators of ≥16 F. The mean dilator size was 14 F. Multivariate logistic regression analysis revealed that preprocedural ureteric stenting and antibiotic use favoured passage of 16-F dilators (odds ratio [OR] 5.16, 95% confidence interval [CI] 1.70-15.62 [P = 0.004] and OR 5.15, 95% CI 1.743-15.243 [P = 0.003], respectively). Neither tamsulosin nor prior urinary tract infection had an impact on ureteric size (OR 0.765, 95% CI 0.281-2.084 [P = 0.601], OR 1.049, 95% CI 0.269-4.089 [P = 0.945], respectively).
Conclusion: Using continuous insertion force monitoring and a 6-N threshold, the majority of unstented adult human ureters within our patient population safely accommodated a 14-F dilator. Safe passage of a 16-F dilator at the 6-N threshold was more likely among patients with a preexisting indwelling ureteric stent or patients who were treated with antibiotics within a week of the procedure.
(© 2024 BJU International.)
Databáze: MEDLINE
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