Analysis Of Clinical Indicators For Ureteral Lesions Secondary To Impacted Stone

Objective: The endoscopic examing results of 103 patients with incarcerated ureteral calculi were retrospectively analyzed to identify the incidence and the risk factors of ureteral lesions secondary to impacted stone.Methods: From November 2018 to April 2020,103 patients were diagnosed incarcerated ureteral stone in the Second Hospital of Tianjin Medical University,and they were first perfomed endoscopic treatment in our urinary surgery.We retrospecticely collected their clinical datas.Spss21.0 software was used for statistical analysis.Measurement data includes age,body mass index(BMI),duration,length of stones,and the maximum ureteral wall thickness(UWT)at the stone side gender.Count data includes gender,history of smoking,history of drinking,history of hypertension,history of type 2 diabetes mellitus(T2DM),affected side of stones,location of stones,degree of hydronephrosis on affected side.According to whether ureteral lesions secondary to impacted stones,they were divided into pathological group and non-pathological group.The differences of clinical datas between the two groups were compared.The pathological group and non-pathological group were statistically analyzed by diagnostic test.Univariate analysis adopted chi-square test、t test or Mann-Whitney rank sum test.The differences were further compared by multivariate logistic regression analysis,and p<0.05 was considered statistically.The ROC curve was performed to predicted the sensitivity,the specificity,and the best predictor of each independent risk factors.Results: The stone removal rate was 93.2% among 103 patients of ureteral impacted calculi.Compared pathological group with non-pathological group,there were 65(63.1%)vs 38(36.9%)cases.The total datas consisted of(52 males and 13females)vs(24 males and 14 females),The ratio of male to female was 4:1 vs1.7:1.The patient’s age ranged from 27 to 86 years vs 36 to 68 years,and median age was 57 years vs 55 years.The patient’s BMI ranged from 20.70 to 31.23 kg·m-2vs 36 to 68 kg·m-2,and median BMI was 25.56kg·m-2 vs 25.93kg·m-2.There were 22 vs13 patients with history of smoking,16 vs 9 patients with history of drinking,33 vs15 patients with history of hypertension,17 vs 4 patients with history of type 2diabetes mellitus(T2DM),respectively.The patient’s duration ranged from 1.33 to180 months vs 0.10 to 360 months,and median duration was 12 months vs 2 months.The patient’s length of stones ranged from 6 to 40 mm vs 8 to 31 mm,and median length of stones was 15 mm vs 13 mm.In these groups,the average UWT was3.38±0.47 mm vs 2.51±0.83 mm,the left side of stones was 41 cases vs 27 cases,the location of stones was 39 upper,17 middle,9 lower vs 24 upper,6 middle,8 lower.and the of hydronephrosis on affected side was 22 mild,37 moderate,6 severe vs 26 mild,12 moderate,0 severe.Under endoscopic observation,we find 49(47.6%)patients with ureteral polyps secondary to impacted calculi,14(13.6%)patients with ureteral strictures secondary to impacted calculi,7(6.8%)patients with tortuous ureter secondary to impacted calculi.The median duration of three lesions were 12.0 months,26.1 months,and 3.7 months,respectively,and significantly higher than that of non-pathological group.Univariate analysis demonstrated that the duration of stones,the degree of hydronephrosis and UWT had statistical significance,between two groups.Multivariate analysis showed that the degree of hydronephrosis and UWT were independent risk factors(OR=3.012,OR=8.303,P<0.05).With regard to the best predictor that might contribute to ureteral lesions formation,we used the ROC curve analysis.The results also identified that UWT was the best predictor.The diagnostic accuracy is 83.9%(95%CI 0.75 ～ 0.92)and the optimal cut-off value of UWT was 3.18 mm.The sensitivity of the value to predict ureteral lesions was 81.1%,and the specificity was 78.9%.Conclusion:The long-term impacted stones were easy to appear ureteral around lesions.The results showed that the degree of hydronephrosis and UWT were independent risk factors of ureteral around lesions secondary to impacted stones.The UWT was the best predictor among them,and when UWT ≥3.18 mm,we should highly suspected that there were polyps,strictures or distortions around the ureter.