Abstract：
OBJECTIVE: To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones.
METHODS: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups.
RESULTS: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option.
CONCLUSIONS: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.
METHODS: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups.
RESULTS: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option.
CONCLUSIONS: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.
摘要：
目的：评估可能影响双侧输尿管结石患者合理治疗决策过程的某些因素。
方法：对来自6个中心的153例双侧输尿管结石患者进行评估，并分为三组。第1组（n：21）接受DJ支架插入输尿管和输尿管肾镜（URS）碎石术治疗对侧输尿管结石的患者。第2组（n：91），输尿管结石和接受双侧DJ支架插入的第3组（n：41）患者的URS碎石术。在三组中对手术的结果和相关患者以及结石相关因素进行了比较评估。
结果：虽然双侧DJ组的尿路感染率和血清肌酐水平明显较高，发现在进行双侧URS的病例中，先前的URS病史明显高于进行双侧DJ支架置入的病例。在输尿管下段结石的情况下，URS的执行频率明显更高，而DJ支架置入术似乎是输尿管上段结石的更合理方法。在输尿管下段结石患者中，更大更硬的石头，内分泌学家倾向于将URS作为第一选择。
结论：在双侧输尿管结石的情况下做出合理的治疗方法是具有挑战性的。我们的研究结果表明血清肌酐水平，相关UTI,结石的位置和硬度以及先前的输尿管镜检查记录可能是在紧急情况下决定JJ支架置入和输尿管镜下取石的重要因素。
方法：对来自6个中心的153例双侧输尿管结石患者进行评估，并分为三组。第1组（n：21）接受DJ支架插入输尿管和输尿管肾镜（URS）碎石术治疗对侧输尿管结石的患者。第2组（n：91），输尿管结石和接受双侧DJ支架插入的第3组（n：41）患者的URS碎石术。在三组中对手术的结果和相关患者以及结石相关因素进行了比较评估。
结果：虽然双侧DJ组的尿路感染率和血清肌酐水平明显较高，发现在进行双侧URS的病例中，先前的URS病史明显高于进行双侧DJ支架置入的病例。在输尿管下段结石的情况下，URS的执行频率明显更高，而DJ支架置入术似乎是输尿管上段结石的更合理方法。在输尿管下段结石患者中，更大更硬的石头，内分泌学家倾向于将URS作为第一选择。
结论：在双侧输尿管结石的情况下做出合理的治疗方法是具有挑战性的。我们的研究结果表明血清肌酐水平，相关UTI,结石的位置和硬度以及先前的输尿管镜检查记录可能是在紧急情况下决定JJ支架置入和输尿管镜下取石的重要因素。
