The efficacy and safety of ureteral dilation and long-term type ureteral stent for patients with ureteral obstruction

ObjectiveThis study was conducted to investigate the efficacy and safety of ureteral dilation and placement of a long-term ureteral stent for patients with various types of ureteral obstructions.MethodsWe retrospectively reviewed the records of 39 patients presenting with ureteral obstruction secondary to malignant strictures (n = 9) or nonmalignant strictures (n = 30). The mean age of these patients was 55.8 ± 16.1 years (range, 13–87 years). All patients underwent retrograde ureteral balloon dilation and placement of one to three ureteral stents. Stent patency rate and complications including febrile urinary tract infection, stent encrustation, and stent fragmentation were recorded.ResultsA total of 117 ureteral stents were implanted during the 83 procedures. Three stents were placed in seven patients and two stents in 20 patients. The patency rate was 95.2% with a mean 75-day follow-up. There was no encrustation in 104 stents and Grade 1 in 13 stents. The patency rate was similar between the patients with malignant strictures and those with nonmalignant strictures (100% vs. 94.7%, p = 0.57). However, three episodes of febrile urinary tract infection were noted only in patients with malignant strictures. The improvement of hydronephrosis and complications were also comparable between those patients with ureteral stents indwelling for >90 days and those for <90 days. No stent fragmentation was found in any of the patients.ConclusionWe demonstrated that ureteral dilation and placement of a single or multiple ureteral stents was effective and safe for patients with ureteral obstruction.     

金属内支架介入治疗恶性输尿管狭窄的临床应用

目的探讨经皮顺行植入输尿管金属内支架治疗恶性输尿管狭窄的效果。方法对14例恶性肿瘤伴输尿管狭窄的患者行经皮顺行植入输尿管金属内支架治疗。术后观察尿量及性状,超声及腹部平片随访。结果14例患者植入输尿管内支架均获成功,输尿管梗阻解除,患者临床症状改善,肾功能好转。结论对恶性输尿管狭窄的患者行顺行植入输尿管金属内支架治疗输尿管狭窄,是一种简便、有效、创伤小的治疗方法。     

输尿管支架置入患者护理评估与干预研究进展

<正>输尿管是连接肾脏与膀胱的肌肉小管,输尿管支架是一种放置于输尿管内起支撑和内引流作用,以维持或重建输尿管畅通的装置^[1]。输尿管支架常被用于缓解或预防因结石、狭窄、肿瘤乃至肾移植等所引发的输尿管腔内外梗阻或吻合口瘘,以提高手术成功率^[2-3]。自1967年首次应用于临床以来,输尿管支架置入技术不断发展,已成为泌尿外科手术中不可或缺的辅助治疗方式^[4]。然而作为异物留置体内,     

金属支架管在解除恶性输尿管梗阻中的疗效评价

目的 评估金属支架管在解除恶性肿瘤所致输尿管梗阻中的临床疗效及影响因素分析.方法 回顾性分析2012年10月至2015年4月在本院留置金属支架管患者47例,根据治疗结果将47例患者分成成功组(n=39)与失败组(n=8),其中采用经尿道逆行留置金属支架管40例,经皮肾顺行留置金属支架管7例,通过术后并发症、血清肌酐、肾盂分离程度、支架管留置的时间及失败率来评估支架管的有效性,通过两组之间的比较分析性别、手术方式及恶性肿瘤类别与失败率之间的相关性.结果 47例患者共留置金属支架管54根,留置后输尿管梗阻解除率100％,患者支架相关并发症发生率为59％(28/47),失败率为17％ (8/47),术后并发症与失败发生率存在一定相关性,与性别、手术方式及恶性肿瘤类别无相关性(P＞0.05).平均随访时间为8个月,支架管平均留置时间为6个月左右,留置时间最长1年半.结论 金属支架管能有效的解除恶性肿瘤所致的输尿管梗阻并防止肾功能进一步恶化,是目前解除恶性输尿管梗阻的一种有效的治疗方案.     

Failure of ureteral stents subject to extrinsic ureteral obstruction and stent occlusions

International Urology and Nephrology - To quantify the occurrence of stent failure and the dynamic behavior of urine flow in ureter-stent systems, including the relative flow in the ureter and...     

Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies

Purpose

To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure.

Materials and methods

The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure.

Results

A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3–476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3–263 days) and 6.5 months (range 4–476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4–398 days) and 7.8 months (range 31–476 days), respectively.

Conclusion

Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration.     

Initial experience with full-length metal stent to relieve malignant ureteral obstruction

Ureteral obstruction caused by extrinsic compression by a malignancy generally can be overcome initially with a ureteral stent. However, the long-term failure rate is high, usually necessitating placement of a nephrostomy tube. Herein, we present the initial case, in this country, of intractable ureteral obstruction managed successfully with the newly developed all-metal Resonance stent (Cook Ireland Ltd., Limerick, Ireland) constructed of MP35N alloy, a composite of nonmagnetic nickel-cobalt-chromium-molybdenum. The patient is a 64-year-old woman with metastatic breast cancer causing retroperitoneal fibrosis and ureteral obstruction diagnosed laparoscopically. The obstruction failed to respond to placement of a single 7F double-J stent and then of two 6F double-J stents in the left ureter. As a last resort, in order to avoid nephrostomy-tube placement, the 6F metal stent was placed; this provided unobstructed flow of urine, as documented on a subsequent Whitaker test and, most recently, on a renal scan, 4 months after initial stent placement.     

输尿管逆行置管和经皮肾造瘘术在糖尿病患者急性感染性输尿管梗阻中的应用

目的比较逆行输尿管置管（USP）和经皮肾造瘘术（PCN）在糖尿病患者急性感染性输尿管梗阻中作为初始引流手术的治疗效果。 方法2018年1月至2021年6月,共118例急性感染性输尿管梗阻的糖尿病患者入组。回顾性收集患者病历数据,比较两组手术失败率、并发症发生情况、肌酐恢复最低值时间、ICU入住率、死亡率。 结果两组共118例患者,通过倾向性得分匹配分析后两组各有30例纳入分析。结果显示,USP和PCN手术的失败率和引流效果相同。在手术时间、疼痛评分、肌酐最低值及达到最低值时间、白细胞恢复正常时间、体温恢复正常时间、ICU入住率方面,两组具有基本相同的结果。在并发症方面,PCN组并发症事件数和并发症病例数均比USP组高（P<0.05）。 结论USP和PCN都可作为糖尿病患者急性感染性输尿管梗阻的初始引流手术,但USP具有更少的并发症优势。     

经皮顺行输尿管支架植入在移植肾输尿管梗阻中的应用11例

目的 探讨经皮顺行输尿管支架植入治疗移植肾输尿管梗阻的有效性和安全性.方法 2009年3月至2011年3月间11例肾移植输尿管梗阻患者,其中急性梗阻2例,慢性梗阻9例.11例梗阻的原因为移植肾输尿管膀胱吻合口狭窄5例,结石梗阻2例,原因不详4例.术前以超声评估移植肾及集合系统,选择合适穿刺部位,在X线透视下完成顺行肾盂和输尿管造影;明确梗阻位置后,通过穿刺针植入斑马导丝直至膀胱,再经膀胱镜从尿道引出斑马导丝,沿斑马导丝顺行植入输尿管支架管,X线下观察输尿管支架上端进入肾盂后,拔除斑马导丝,再次透视,确认支架管位置.移植肾肾盂造瘘管引流1～2周后拔除,输尿管支架在术后半年至1年内取出.在术后1周、1个月、3个月、6个月行B型超声及肾功能检查,之后每隔半年检查.结果 11例中10例手术成功,1例因输尿管狭窄段过长置管失败.输尿管支架植入手术耗时为(54±27) min,患者血清肌酐由术前(326±147) μmol/L下降至术后(89±49) μmol/L.随访6～27个月,患者均未发生并发症.结论 经皮顺行输尿管支架植入治疗移植肾输尿管梗阻是一种安全、有效的方法.     

输尿管支架在恶性肿瘤引起的输尿管梗阻治疗中的应用新进展

正恶性肿瘤引起的输尿管梗阻(malignant ureteral obstruction,MUO)通常由盆腔恶性肿瘤局部侵犯或压迫输尿管导致,大多数病例来自妇科、消化道及腹膜后肿瘤,且肿瘤的放化疗导致输尿管周围纤维化会加重梗阻的程度,此类患者如不进行治疗,将很快出现上尿路功能损害,甚至器官功能衰竭。上尿路减压和维持输尿管通畅为首选的治疗方案,治疗的目标是解除输尿管梗阻,避免泌尿系统的并发症,为患者提供继续治疗原发肿瘤的机会。随着技术进步及新材料的开发,各种输尿管支架包括聚合物输尿管支架、金属输尿管支架被应用于临床治疗MUO,为泌尿外科医师提供了更多的选择,同时有助于提高患者生活质量。     

Urinary PGE2 in rats with chronic partial unilateral ureteral obstruction

Urinary prostaglandin E2 (PGE2) was measured in Munich-Wistar rats with surgically created chronic partial unilateral ureteral obstruction (UUO). Mean values of bladder urine PGE2 were higher in sham than in UUO (24.5 +/- 14.4 vs 12.9 +/- 8.2 ng/mg creatinine, respectively, P less than 0.05). Following diuresis, both ureters were cannulated and urine was collected. PGE2 excretion was increased in sham (66.5 +/- 34.4 and 70.1 +/- 44.5 ng/mg creatinine, left and right, respectively). But in UUO, the obstructed kidney excreted less PGE2 than the contralateral kidney (32.1 +/- 6.0 vs 62.3 +/- 40.4 ng/mg creatinine, obstructed vs contralateral, respectively, P = 0.08). PGE2 synthesis was then determined in separated renal medullary and cortical slices. Renal medullary slices from kidneys with severe obstruction synthesized less PGE2 than the contralateral unobstructed side (3.30 +/- 1.22 vs 10.52 +/- 3.23 ng/mg wet wt-30 min, respectively, P less than 0.05) and failed to respond to arachidonic acid stimulation with any significant increase in PGE2 synthesis (3.30 +/- 1.22 vs 4.47 +/- 1.04 ng/mg wet wt-30 min, baseline vs stimulated). In contrast, contralateral unobstructed kidney slices responded with a significant increase in PGE2 synthesis (10.52 +/- 3.23 vs 21.10 +/- 2.50 ng/mg wet wt-30 min, baseline vs stimulated, P less than 0.05). We conclude that chronic partial UUO in the Munich-Wistar rats resulted in significantly less PGE2 elaboration.     

Spontaneous urinary extravasation due to chronic ureteral obstruction

Spontaneous nontraumatic perirenal extravasation of urine is an unusual phenomenon, and the majority of the reported case were caused by acute obstruction with passage of a ureteric calculus. Extravasation due to obstruction of more gradual onset occurs less frequently. We report four cases, three caused by tumor obstruction of the ureter, and one thought to be obstructed by the stricture due to ureteral inflammation. We discuss the diagnosis and treatment of spontaneous urinary extravasation, especially due to chronic ureteral obstruction.