Analysis Of Influencing Factors Of Postoperative Ureteral Stricture In Patients With Upper Ureteral Incarcerated Stones

Background and ObjectiveUreteral incarcerated calculi were defined as a type of calculi that were fixed in the same position of the ureter for at least 2 months,and/or during imaging examination(including intravenous pyelography and CT urography),the contrast agent stopped at the obstruction site and failed to pass through,resulting in the absence of development of the following site.For non-incarcerated ureteral calculi,extracorporeal shock wave lithotripsy was often used clinically,but the lithotripsy efficiency for incarcerated calculi was relatively low.Foreign literature reports that the lithotripsy efficiency for incarcerated calculi by extracorporeal shock wave lithotripsy was only 19.8%.At present,the treatment methods of ureteral calculi are more surgical,such as ureteroscopy,percutaneous nephrolithotomy and laparoscopic ureterolithotomy,etc.Compared with common ureteral calculi,the obstruction time of incarcerated calculi is longer,ureteral edema and fibrosis are more likely to occur,and ureteral stricture is more likely to occur after surgery.Surgery had made great progress and treating calculi was no longer a problem.The occurrence of ureteral stricture was a difficult point in clinical treatment.Therefore,in order to find out the indicators that can be used to quantitatively evaluate the postoperative ureteral stricture in patients with incarcerated ureteral calculi,this study retrospectively analyzed 461 cases of incarcerated ureteral calculi in the upper ureteral segment,in order to screen out the best predictors of ureteral stricture after ureteral calculi and provide corresponding clinical guidance.Materials and methods461 patients with incarcerated upper ureteral calculi who treated by surgery in the second affiliated hospital of zhengzhou university from January 1,2014 to January 1,2019 were selected as the study objects.The patients were divided into the ureteral stricture group and the non-ureteral stricture group according to the postoperative aggravation of hydronephrosis.The general data(gender,age)and clinical data(calculi location,calculi size,calculi CT value,preoperative hydronephrosis degree,ureteral width above calculi,ureteral wall thickness at calculi location and ureteral polyp growth around calculi)were compared between the two groups.Single factor analysis was used to screen the difference factors with statistical significance between the two groups.Logistic multivariate analysis was used to determine Independent influencing factor of ureteral stricture.Finally,the best predictor was determined by ROC curve analysis of each predictor.ResultsSingle factor analysis results showed that there was no statistically significant difference in general information(gender,age,etc.)between the two groups(P>0.05),there was no statistically significant difference between the two groups in the stone location,the largest diameter of the stone and the CT value of the stone(P>0.05),the differences in ureteral wall thickness,ureteral width above the calculi,ureteral growth with polyp around the calculi and preoperative hydronephrosis were statistically significant(P<0.05).The results of multivariate analysis showed that the ureteral wall thickness at the calculi site,ureteral width above the calculi and ureteral polyp growth around the calculi were Independent influencing factor of postoperative ureterostenosis in patients with ureteral upper segment incarcerated calculi(P<0.001).The ROC curve analysis results showed that the area under the curve of ureteral wall thickness around the calculi was the largest(AUC=0.842,P<0.001).Conclusions(1)Preoperative measurement of ureteral width above the calculi,ureteral wall thickness around the calculi,and ureteral growth with polyp around the calculi is helpful to determine whether ureteral stricture occurs after surgery;(2)Ureteral wall thickness around calculi(UWT)is the best predictor of postoperative ureterostenosis in patients with incarcerated ureteral calculi,with an optimal predictive value of 2.595mm,a specificity of 88.6%,and a sensitivity of 74.5%.