Influencing factors of ureteral stricture after ureteroscopic holmium laser lithotripsy for ureteral calculi

Yang Junxian; Ai Qian; Shi Wenxiu

doi:10.3969/j.issn.1674-3245.2024.06.027

Abstract：Objective To study the influencing factors of ureteral stricture(US)after ureteroscopic holmium laser lithotripsy(URHL)for ureteral calculi,and to construct its prediction model,and to analyze the predictive value of the prediction model for US in patients with ureteral calculi after URHL treatment.Methods The clinical data of 425 patients with ureteral calculi treated by URHL in Wuhan Puren Hospital from January 2019 to February 2023 were retrospectively collected.All patients were followed up for 1 year after operation.During the follow-up period,4 cases were lost to follow-up,and 421 cases were finally included.According to whether ureteral stenosis occurred during the follow-up period,42 cases were divided into the occurrence group and 379 cases in the non-occurrence group.The influencing factors of US after URHL in patients with ureteral calculi were analyzed,and the prediction model was constructed.The predictive value of the prediction model for US after URHL in patients with ureteral calculi was analyzed.Results In the group with ureteral stricture,the course ofdisease was more than 3 months,the length and diameter of stones were more than 2 cm,stones were incarcerated,the degree of hydronephrosis was severe,the thickness of ureter wall at the stone site was more than 2 mm,polyps wrapped stones,inflammatory mucosa encapsulated stones,patients with mucosal injury by holmium laser were higher than that of patients without ureteral stricture,with statistically significant differences(χ2=36.065,44.939,17.127,42.202,7.102,34.742,5.202,9.107,P<0.05).Multivariate logistic regression analysis showed that the course of the disease was more than 3 months,the length diameter of the stone was more than 2 cm,the stone was incarcerated,the hydronephrosis was severe,and the thickness of the ureteral wall at the stone was more than 2 mm,polyp wrapped stones,mucosal injury by Holmium laser were independent risk factors of US after URHL treatment in patients with ureteral calculi(OR=1.874,2.036,1.697,1.565,1.996,1.774,1.866,P<0.05).According to the results of multivariate analysis,a prediction model was constructed:logit(P)=-8.916+course of disease×0.628+stone length×0.711+stone incarceration×0.529+degree of hydronephrosis×0.448+stone ureteral wall thickness×0.691+polyp wrapped stone×0.573+holmium laser damage mucosa×0.624.Hosmer-Lemeshow goodness-of-fit test showed Chi-Square=7.003,DF=6,P=0.597.The results of receiver operating characteristic curve(ROC)analysis showed that when logit(P)>13.67,the area under the curve(AUC)of the prediction model for predicting the occurrence of US after URHL in patients with ureteral calculi was 0.850,the sensitivity was 71.43%,and the specificity was 88.92%.Conclusion The independent risk factors for US after URHL in patients with ureteral calculi included course of disease>3 months,long diameter of calculi>2 cm,calculi incarceration,severe hydronephrosis,ureteral wall thickness at calculi>2 mm,polyp wrapped stone,and holmium laser injury of mucosa.The prediction model constructed based on this has good predictive value.