无管输尿管镜：综合文献综述
Tubeless Ureteroscopy: A Comprehensive Literature Review.
摘要(中文译文)
输尿管镜术后省略支架置入，即在不放置术后输尿管支架的情况下进行输尿管镜碎石治疗，已从实验性概念演变为一种获得指南认可的、适用于经过适当选择患者的规范化实践。现有证据与临床采纳之间仍存在持续差距，全球大多数中心在输尿管镜手术后仍以放置输尿管支架为主要做法，反映出临床谨慎与循证医疗之间的持续张力。本综合文献综述汇总了截至2026年2月发表的随机对照试验、系统评价、荟萃分析、登记研究及前瞻性队列研究的证据，这些研究考察了无支架输尿管镜术的安全性、有效性、患者报告结局、医疗资源利用及患者选择标准。关键发现一致表明，在无并发症病例中省略支架可减轻下尿路症状、血尿及支架相关并发症负担，而不显著增加术后并发症或非计划医疗就诊的风险。不断发展的技术，包括激光粉末化技术、高功率钬激光和铥光纤激光、负压输尿管通路鞘及一次性软性输尿管镜，进一步扩大了无支架方法的候选人群。SOUL研究及2025年多中心随机对照试验等里程碑式试验提供了支持省略支架的最严谨的现代证据。无支架输尿管镜术是安全的，在患者体验方面更优，值得在经过适当选择的患者中更广泛地采用。当前证据支持美国泌尿外科学会（American Urological Association）和欧洲泌尿外科学会（European Association of Urology）指南关于在无并发症病例中省略支架的建议。
Abstract
Stent omission post-ureteroscopy, defined as performing ureteroscopic stone treatment without placement of a postoperative ureteral stent, has evolved from an experimental concept to a recognized, guideline-endorsed practice for appropriately selected patients. A persistent gap exists between the available evidence and clinical adoption, with ureteral stent placement remaining the predominant practice following ureteroscopic procedures at most centres worldwide, reflecting ongoing tension between clinical caution and evidence-based care. This comprehensive literature review synthesizes evidence from randomized controlled trials, systematic reviews, meta-analyses, registry studies, and prospective cohort studies examining the safety, efficacy, patient-reported outcomes, healthcare utilization, and patient selection criteria for tubeless ureteroscopy published through February 2026. Key findings consistently demonstrate that stent omission in uncomplicated cases reduces lower urinary tract symptoms, hematuria, and stent-related morbidity without meaningfully increasing the risk of postoperative complications or unplanned healthcare encounters. Evolving technologies, including laser dusting techniques, high-powered holmium and thulium fiber lasers, suction ureteral access sheaths, and single-use flexible ureteroscopes, have further expanded the candidate pool for stentless approaches. Landmark trials such as the SOUL study and a 2025 multicenter randomized controlled trial provide the most rigorous modern evidence supporting stent omission. Tubeless ureteroscopy is safe, superior for patient experience, and warranting of broader adoption in appropriately selected patients. Current evidence supports American Urological Association and European Association of Urology guideline recommendations for stent omission in uncomplicated cases.
如何引用
AMA
Ahmed S Aboelatta. Tubeless Ureteroscopy: A Comprehensive Literature Review.. Cureus. 2026; doi:10.7759/cureus.109232.
APA
Ahmed S Aboelatta (2026). Tubeless Ureteroscopy: A Comprehensive Literature Review.. Cureus. https://doi.org/10.7759/cureus.109232
GB/T 7714
Ahmed S Aboelatta. Tubeless Ureteroscopy: A Comprehensive Literature Review.[J]. Cureus, 2026 doi:10.7759/cureus.109232.
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