Analysis Of Incidence And Risk Factors Of Ureteral Stricture After Ureteral Calculi Operation

Objective: To analyze the incidence and risk factors of Ureteral stricture after surgical treatment of ureteral calculi,For clinical prevention and reduction of ureteral postoperative ureteral strictures.Methods: The clinical data of patients with ureteral calculi treated by surgery in the Department of Urology of our hospital from January 2020 to January 2022 were retrospectively analyzed.The incidence of ureteral stricture after ureteral calculi surgery was calculated.Univariate analysis was used to compare the BMI,gender,age,past chronic medical history,history of ipsilateral ureteral calculi surgery,preoperative ASA score,stone location,maximum transverse diameter of stones,CT value of stones,degree of hydronephrosis before surgery,ureteral width above the stone,urography below the stone,and preoperative stone location in patients with ureteral stricture after surgery Ureteral wallthickness,preoperative urinalysis,preoperative urine culture,preoperative serum creatinine,operation method,operation time,intraoperative growth of ureteral polyps around stones,intraoperative use of glucocorticoids and diuretics,postoperative fever,postoperative renal colic,postoperative use of antibiotics,postoperative ureteral stent placement time,etc.The significant influencing factors of ureteral stricture in univariate analysis were analyzed by multivariate logistic regression to further analyze the independent risk factors of ureteral stricture after ureteral stone surgery.According to the obtained independent risk factors,the ROC curve was drawn to compare the predictive value of each independent risk factor for ureteral stricture after ureteral calculi surgery.Results: From January 2020 to January 2022,a total of 1028 patients with ureteral calculi were admitted to the Department of Urology of our hospital,of which 952 patients underwent surgical treatment(877 patients were included in this study),26 patients had postoperative ureteral stricture,and the rate of ureteral stricture after ureteral calculi surgery was 2.73%.Twenty-six patients with stenosis and 851 patients without stenosis were included in this study.Univariate analysis showed that: The previous history of ipsilateral ureteral calculi surgery,the maximum transverse diameter of the stone,the degree of hydronephrosis before surgery,the width of the ureter above the stone before surgery,the increase of red blood cells in urinalysis before surgery,the thickness of the ureteral wall at the site of the stone,the development of the stone below the urography before surgery,the operation time,and the ureteral polyps around the stone during surgery were compared between the patients with and without ureteral stricture after stone surgery The differences in growth,postoperative indwelling ureteral stent time and other data were statistically significant(P < 0.05),while BMI value,gender,age,preoperative ASA score,history of hypertension,history of diabetes,stone location,stone CT value,preoperative serum creatinine increase,preoperative urine analysis white blood cell increase,preoperative urine culture positive,surgical method,intraoperative glucocorticoid and diuretics There was no significant difference in the use of urine agents,postoperative fever,postoperative renal colic,and postoperative use of antibiotics between the two groups(P > 0.05).The results of multivariate logistic analysis were:preoperative ureteral wall thickness at the stone site(OR = 20.078,95% Cl: 6.351-63.476,<0.001),preoperative severe hydronephrosis(OR = 9.253,95% Cl: 1.279-66.912,P = 0.028),peristone ureteral polyp growth(OR = 8.370,95% Cl: 1.672-48.892,P=0.010)were the independent risk factors for postoperative ureteral stricture in patients with ureteral calculi,and the increase of preoperative urine routine urine red blood cell(B =-1.421,OR = 0.241,95% Cl:0.080-0.728,P= 0.012)was the protective factor for postoperative ureteral stricture.ROC curve analysis showed that the Area under curve(AUC)of the ureteral wall thickness at the stone site was the largest(AUC=0.909,P<0.001).The second largest area under the curve was severe preoperative hydronephrosis(AUC=0.0.835,P<0.001),and the smallest area under the curve was the growth of ureteral polyps around the stone during the operation(AUC= 0.797,P<0.001).Ureteral wall thickness at the stone site was the best predictor,and the optimal predictive value was 3.045 mm,the specificity was 89.4%,and the sensitivity was 76.9%.Conclusion: The incidence of ureteral stricture in patients after ureteral calculi operation from January 2020 to January 2022 in the Department of Urology in our hospital was 2.73%.Preoperative ureteral wall thickness at the site of calculi,preoperative severe renal hydronephrosis and intraoperative observation of ureteral polyp growth around calculi are independent risk factors for postoperative ureteral stricture in patients with ureteral calculi.The best predictive ability is the preoperative ureteral wall thickness at the site of calculi,the critical value(optimal predictive value)is 3.045 mm,the specificity is 89.4%.The sensitivity is 76.9%.