Abstract: Objective To evaluate the therapeutic effectiveness and safety of flexible ureteroscopes without preoperative ureteral stent placement based on the real world study. Methods A total of 351 patients who underwent flexible ureteroscopy (FURS) lithotripsy in The Urology Department of Chengdu Fifth People's Hospital from January 2018 to November 2021 were collected. Based on the real world study, 293 patients without preoperative indwelling of ureteral stents were divided into non-stented group, and the remaining 58 patients with preoperative indwelling of ureteral stents were divided into pre-stented group under the premise of fully informing patients whether to choose preoperative indwelling of ureteral stents.. The operative time, length of hospital stay, stone-free rates (SFRs) (3 days post-operation and 30 days post-operation), complications, and hospital costs of the two groups were respectively compared. Results The average operative time of Pre-stented group was longer than that of Non-stented group (P=0.1680), the SFRs of Pre-stented group were significantly higher than those of Non-stented group at 3 days postoperatively（P=0.0323). However, no significant difference was found in the SFRs between two group 30 days postoperatively（P>0.05), and no difference in complications rates between two groups. The average length of hospital stays and the average hospital costs were substantially lower in Non-stented group than those in Pre-stented group（P<0.05). Conclusions These results indicated that preoperative ureteral stent placement is not necessary in FURS , and without pre-stented ureteral stent is effective and safe for the treatment of upper urinary calculi through FURS.

Key words: flexible ureteroscopy, upper urinary calculi, ureteral stent, real world study

摘要： 目的 基于真实世界研究评价输尿管软镜治疗前是否需要留置支架管的效果及必要性。方法 收集2018年1月~2021年11月于成都市第五人民医院泌尿外科行输尿管软镜碎石术（flexible ureteroscopy,FURS）患者351例。采用真实世界研究,充分告知是否选择术前留置输尿管支架管患者前提下,将术前未留置输尿管支架293例分为Non-stented组,其余58例术前行输尿管支架置入术分为Pre-stented组。分别收集两组患者手术时间、住院时间、并发症发生率及住院费用,计算出术后3d结石清除率及术后一月无结石率（stone-free rates,SFRs）进行比较。结果 Pre-stented组平均手术时间短于Non-stented组,但无统计学差异（P=0.1680）;3d结石清除率Pre-stented组较Non-stented组高(P=0.0323）,但术后1月无结石率并未见显著差异（P>0.05）,且并发症发生率两组并未见显著统计学差异;Pre-stented组累计住院时间长于Non-stented组（P=0.0493）,且Pre-stented组累计住院诊疗费用较Non-stented组显著增加（P<0.0001）。结论 FURS治疗中术前未留置输尿管支架是安全的, FURS术前无需常规留置输尿管支架。

关键词: 输尿管软镜, 上尿路结石, 输尿管支架, 真实世界研究