中老年人输尿管梗阻导致肾积水的病因及诊断分析

目的　提高中老年人输尿管梗阻的病因诊断水平。　方法　回顾性分析了近 10年来收治的 141例中老年人肾积水的病因及诊断方法。　结果　在本组病例中 ,输尿管结石 5 9例 ,输尿管癌 5 1例 ;输尿管结核 11例 ;肾盂输尿管交界处狭窄 9例 ;输尿管囊肿 6例 ;输尿管息肉 5例。　结论　输尿管结石和肿瘤是导致中老年人输尿管梗阻的主要病因 ,对于这些病因的诊断 ,尤其伴有血尿的患者 ,B超应作为诊断及定期复查的首选检查手段。     

Ureteric stent card register - a 5-year retrospective analysis

INTRODUCTION

Ureteric stenting is a common urological procedure. Forgotten stents have a well-documented morbidity and mortality. Therefore, we asked the question, is a stent register an important factor in reducing the number of lost or overdue stents?

PATIENTS AND METHODS

We conducted a retrospective review of 203 patients who had ureteric stents inserted in the operating theatre, for the 5-year period 1 December 1998 to 1 December 2003. We analysed all stent cards, patient notes and theatre logs; where no record of stent removal was found, we contacted the patient, their GP or their local hospital.

RESULTS

A total of 191 patients were identified from the stent card register. An additional 12 patients were found from the theatre logs, but with no record in the stent card register. Of the 203 patients, 8 had bilateral stents. The most common indication for stenting was stone disease. Of the 203 patients, 11 had overdue stents and 51 had no record of the stents ever being removed. The 51 presumed ‘forgotten’ stents were traced, and it was found that 42 patients had had their stents removed by other hospitals, and 9 patients died with stents in situ, but before they were due for removal.

CONCLUSIONS

Our current stent card tracking system is ineffective, because it was infrequently reviewed. However, despite overdue and ‘forgotten’ stents which were removed by other hospitals, no patients came to any real harm and we had no lost stents. Our stent register system did not appear to play any role in terms of preventing stent loss, and it seems likely that there are other more effective safeguards in place to prevent this from happening. However, if a stent register was required at all, a computerised system would be preferable. Alternatively, patients could share some of the responsibility of stent tracking with their clinicians.     

恶性肿瘤继发输尿管狭窄的超声引导经皮穿刺顺行输尿管支架管置人治疗

目的：探讨超声引导经皮穿刺顺行输尿管支架管置入术治疗恶性肿瘤引起的输尿管狭窄导致的。肾功能衰竭的应用价值及安全性。方法：对11例患者经超声引导下行双侧肾盂穿刺,透视下双侧顺行放置输尿管支架管,术后观察肾功能恢复情况。结果：11例共22只输尿管支架管置放术均一次成功,无严重并发症出现。术后1周血肌酐、尿素氮恢复正常。术后经肾脏超声、CT随访检查,肾盂、输尿管扩张积水均消失,患者腰痛症状消失。术后生存时间4～12个月,平均5个月,患者最终因肿瘤进展而死亡。结论：超声引导经皮穿刺顺行输尿管支架管置人术,治疗原发或转移性恶性肿瘤引起的输尿管狭窄导致的肾功能衰竭安全可靠、并发症少,可有效延长患者的生存期,改善生存质量。     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

Predictors of morbidity in patients with indwelling ureteric stents: results of a prospective study using the validated Ureteric Stent Symptoms Questionnaire

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Although it has long been known that ureteric stenting is associated with significant morbidity in a high proportion of patients, predictors of morbidity remain largely elusive. In a multivariable analysis of potential predictors of morbidity using the Ureteric Stent Symptoms Questionnaire, an easy‐to‐determine variable, i.e. the location of stent distal loop with respect to body midline, emerged as the strongest predictor of morbidity. Patients with stent distal loop crossing the midline experienced worse symptoms. The visualization of stent distal loop may, thus, help identify patients at higher risk of morbidity requiring early management. OBJECTIVE To assess the predictors of morbidity in patients with indwelling ureteric stents using a validated questionnaire. PATIENTS AND METHODS Eighty‐six consecutive patients with indwelling double‐J ureteric stent of different length and size enrolled at an Italian tertiary academic centre were prospectively evaluated with the Italian‐validated Ureteric Stent Symptoms Questionnaire (USSQ), which explores the stent‐related symptoms in six domains. Ureteric stents were placed for benign ureteric obstruction or after uncomplicated ureterorenoscopy, and were all removed after 28 days. The questionnaire was administered on days 7 and 28 after stent placement and on day 28 after removal. A plain abdominal X‐ray was performed on days 7 and 28 after placement to determine stent location. Univariable and multivariable analyses tested the association of patient age, sex and body mass index (BMI), and stent side, length, calibre and distal loop location, with the index score of the various domains on days 7 and 28. RESULTS All patients completed the study. At multivariable analysis, on day 7, sex, BMI and stent calibre were significantly associated with one domain (general health, body pain and work performance, respectively), while location of stent distal loop was significantly associated with five domains (urinary symptoms, body pain, general health, work performanc, and sexual matters). On day 28, body mass index was significantly associated with two domains (body pain and general health), while location of stent distal loop remained significantly associated with the same five domains (urinary symptoms, body pain, general health, work performance and sexual matters). CONCLUSION Location of stent distal loop with respect to midline had the strongest association with most domains of the USSQ on both days 7 and 28 after stent placement. The visualization of stent distal loop crossing the midline may therefore identify patients at higher risk of post‐procedural morbidity requiring early management.     

输尿管镜气压弹道碎石术治疗输尿管结石221例

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的效果。方法2003年1月～2007年6月，对输尿管结石221例，采用单腿截石位（架健侧腿患侧下肢平放外展），在腰麻硬膜外联合麻醉下行输尿管镜气压弹道碎石术，碎石取石后常规留置双J管作为支架引流。结果221例手术时间15～118min，平均55min。结石位于上段16例、中段52例、下段153例，228枚结石均原位粉碎，碎石成功率100％，术中结石排净率为95．5％（211／221），7例碎石不满意及3例伴同侧肾结石者术后ESWL治愈。189例随访3～6个月，无结石残留及复发。结论输尿管镜气压弹道碎石术治疗输尿管结石创伤小、疗效好，术后联合ESWL术可以提高结石清除率，是一种可供选择的治疗方式。     

Ureteric stricture: an unusual presentation of metastatic prostate adenocarcinoma

We describe an unusual case of a prostatic adenocarcinoma presenting with a ureteric stricture secondary to a discrete metastatic lesion. A 76-year-old man presented with a short history of right loin pain. Initial examination was unremarkable, digital rectal examination was normal and prostate specific antigen was within normal range. Computed tomography showed right hydronephrosis and a distal ureteric stricture. A distal ureteric transitional cell carcinoma was thought to be most likely. A nephroureterectomy was carried out and histology revealed a skipped lesion of a metastatic prostate adenocarcinoma. Metastatic lesions to the ureters due to prostate cancer are rare. It was believed to be secondary to a transitional cell carcinoma as there was no evidence initially to suggest prostatic disease as the cause. A prostatic adenocarcinoma should be considered in the differential diagnosis of any lesions in the ureter believed to have a malignant origin.     

舒铂生物材料鼻支架与自体肋软骨鼻支架在隆鼻术中的应用效果

比较舒铂生物材料鼻支架与自体肋软骨鼻支架在隆鼻术中的应用效果。方法 抽取中国医科 大学空军特色医学中心2021年4月-2023年5月收治的100例隆鼻术患者为研究对象，采用随机数字表法分 为对照组和观察组，各50例，对照组予以自体肋软骨鼻支架隆鼻术治疗，观察组予以舒铂生物材料鼻 支架隆鼻术治疗，比较两组并发症发生情况、切口愈合情况及鼻部美学指标水平。结果 观察组并发 症发生率为2.00%，低于对照组的8.00%，差异无统计学意义（P ＞0.05）；观察组切口Ⅰ级愈合率为 88.00%，略低于对照组的92.00%，但差异无统计学意义（P ＞0.05）；两组术后6个月鼻面角、鼻尖角 均高于术前，且观察组高于对照组（P ＜0.05）。结论 采用舒铂生物材料鼻支架、自体肋软骨鼻支架进 行隆鼻术术后后并发症发生风险及切口愈合情况相近，而舒铂生物材料鼻支架隆鼻术鼻部美学效果更 佳，值得临床应用。     

利尿性肾图在评估小儿上尿路扩张术后疗效中的价值

目的　探讨利尿性肾图 (DR)在评估小儿上尿路扩张术后疗效中的价值。　方法　对5 4例 (6 6侧 )上尿路扩张术后患儿随访资料进行回顾性分析。　结果　 5 4例患儿根据肾血流灌注率(BPR)值分为轻、中、重度三组。轻、中度组 (49侧 )肾图术前为无排泄相的梗阻图型 ,术后排泄相出现 ,其中注射速尿后明显下降者 37侧 ,无变化 12侧。重度组 (17侧 )BPR术前为 (2 3.8± 3.5 ) % ,术后为 (33.4± 6 .4 ) % ,差别有显著性意义 (P <0 .0 1)。肾图术前为低平的梗阻图型 ,术后吸收排泄相有所改善 ,注射速尿后曲线加快下降者 10侧 ,无变化 7侧。 2例术后 2周和 4 0d复查DR ,肾图曲线由术前排泄延迟型转为梗阻型 ,半年后又转为排泄延迟型。　结论　肾图曲线变化是判断轻、中度上尿路扩张术后疗效的重要指标。BPR是判断重度上尿路扩张术后肾功能恢复的重要指标。DR随访时间以术后半年为宜     

Impact of Double-J Ureteric Stent in Kidney Transplantation: Single-Center Experience

We retrospectively evaluated the use of double-j stent and the incidence of urological complications in 2 groups of patients who received a kidney transplant. From January 2005 to September 2007 we studied 172 patients receiving kidney transplants, 65 and 107 from living and cadaver donors, respectively. From the 172 patients, a total of 34 were excluded due to ureterostomy or Politano-Leadbetter ureterovesical anastomosis. Another 21 patients were excluded from the study due to graft loss due to acute or hyperacute rejection, cytomegalovirus (CMV) infection, or vascular complication. The remaining patients were divided into 2 groups: group A (44 patients) and B (73 patients) with versus without the use of a double-j-stent, respectively. The 2 groups were comparable in terms of donor and recipient gender, ischemia time, and delayed graft function. We failed to observes significant differences between the 2 groups in mean hospital stay (23 ± 9 and 19 ± 9), urinary leak (2.3% and 4.1%), and urinary tract infection (20.4% and 19.2%), among groups A and B, respectively. The only difference observed concerned the gravity of the urinary leak; no surgical intervention was needed among the double-j stent group versus 2 patients demanding ureterovesical reconstruction in the nonstent group. In conclusion, our data suggested that the routine use of a double-j stent for ureterovesical anastomosis neither significantly increased urinary tract infection rates, nor decreased the incidence of urinary leaks, but may decrease the gravity of the latter as evidenced by the need for surgical intervention.     

Double Sigmoid Colon Perforation by a Migrated Biliary Stent

The case of a female patient with a covered double perforation of the sigmoid colon is described. The perforation was due to a migrated plastic biliary stent inserted 3 weeks earlier for benign biliary obstruction and was facilitated by the presence of expressed diverticulosis of the colon. The lack of peritonitis and the early surgical procedure allowed a successful primary reconstruction after the colonic resection. Since the use of biliary stents is constantly increasing, such complications as stent migration and perforation should always be kept in mind by surgeons.     

Experimental Evaluation of a New Antithrombogenic Stent Using Ion Beam Surface Modification

A new antithrombogenic stent using ion beam surface modification nanotechnology was evaluated. The ion stent is being developed to inhibit acute and chronic stent-related thrombosis. Thirty self-expanding mesh stents were fabricated from Ti-Ni metal wires with a dimension of 4 mm (diameter) × 25 mm (length) × 0.15 mm (thickness). Twenty stents were coated with type I collagen and irradiated with a He⁺ ion beam at an energy of 150 keV with fluences of 1 × 10¹⁴ ions/cm² (ion stent group). Ten stents had no treatment (non-ion stent group). The self-expanding stents were implanted into the right and left peripheral femoral arteries of 15 beagle dogs (vessel diameter approximately 3 mm) via a 6Fr catheter under fluoroscopic guidance. Heparin (100 units/kg) was administered intravenously before implantation. Following stent implantation, no antiplatelet or anticoagulant drugs were administered. The 1-month patency rate for the non-ion stent group was 10% (1/10), and for the ion stent group it was 80% (16/20) with no anticoagulant or antiplatelet drugs given after stent implantation ( P  = 0.0004 by Fisher's exact test). Ten stents remain patent after 2 years in vivo with no anticoagulant or antiplatelet drugs. These results indicate that He⁺ ion-implanted collagen-coated Ti-Ni self-expanding stents have excellent antithrombogenicity and biocompatibility. This ion stent is promising for coronary and cerebral stent applications.       

Iatrogenic Ureteric Injuries: Incidence,Aetiological Factors and the Effect of Early Management on Subsequent Outcome

Objective: To investigate the changing pattern in incidence, aetiological factors and the effect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries in our Urology Unit over a 5 year period. Patients/Methods: All patients with ureteric injuries caused as a result of any surgical procedures (iatrogenic ureteric injuries) were studied during a 5 year period (1998–2002). Data collected and analysed included yearly incidence of injury, aetiological factors, modalities of treatment and the outcome of management of the injuries. During the study period, our general surgical colleagues had a policy of requesting “J” stent insertion prior to major abdominopelvic surgical procedures. During the same period, in nearly all difficult cases of ureteroscopy (URS) + lithoclast lithotripsy±Dormia basket, a ureteric catheter or “J” stent was prophylactically inserted by urological surgeons. Results: There were 82 iatrogenic ureteric injuries in 75 patients over the 5 year period. The total number of iatrogenic ureteric injuries declined from 26 (31.7%) in 1998 to 10 (11.8%) in 2002. Urological, obstetrics and gynaecological and general surgical procedures were involved in 69(84.1%), 7(8.7%), and 4(4.9%) of the injuries respectively. The commonest types of injuries encountered were; injury to ureteric mucosa post URS or lithoclast calculi disintegration 34 (41.5%), complete ureteric perforation 15 (18.3%) and false passage 15 (18.3%). The most severe complications encountered were complete ureteric avulsions 3 (3.75%) and loss of ureteral segment 2 (2.4%). The commonest treatment options used were “J” stent insertion or ureteric catheter placement (48, 59.4%), percutaneous nephrostomy (17, 20.7%), laparotomy and removal of suture on tied ureters (5, 6.1%). Two (2.4%) nephrectomies were performed because of poor renal function in one patient and severe damage to a functioning renal unit during a difficult retroperitoneal surgery in another patient. Recognition and treatment of ureteric injuries at the time of surgery was associated with less morbidity compared to those in whom the diagnosis was delayed. The overall successful resolution of ureteric injuries in this series was 77/82 (93.9%). There was no mortality attributable to these ureteric injuries. Conclusion: In our Unit, the incidence of significant iatrogenic ureteric injuries has shown a decline over a 5-year period. We attribute this trend to the prophylactic use of “J” stents or ureteric catheter placement and good surgical technique during major abdomino-pelvic surgeries in our hospital. Endourological procedures are the commonest causes of ureteric injuries. Prompt diagnosis and institution of appropriate corrective surgical procedures often result in a very satisfactory outcome in about 94% of cases.     

Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation

Background

Ureteral stents have been widely used in kidney transplantation to prevent postoperative ureter-related complications such as ureteral stricture, ureteral obstruction, and ureteral leakage; however, a longer indwelling ureteral stent time corresponds to a greater risk of complications such as urinary tract infections. Currently, transplantation centers have not yet reached an agreement on the time to remove ureteral stents. Several randomized controlled trials (RCTs) have evaluated the optimal removal time for ureteral stents.

Ureteric stenting after ureteroscopy for ureteric stones: a prospective randomized study assessing symptoms and complications

OBJECTIVE: To compare patients with and with no stenting after ureteroscopy for ureteric calculi, as placing such stents is routine, although many patients complain of pain and urinary symptoms. PATIENTS AND METHODS: In all, 45 patients with ureteric calculi amenable to ureteroscopic management were prospectively randomized into a stented (23) or an unstented (22) group. Standard ureteroscopic basketing and lithotripsy was used, through a ureteroscope (8.5 F) with or without ureteric dilatation. Symptom questionnaires were completed by the patients after treatment, and they were followed radiographically to assess stone-free rate and evidence of obstruction. RESULTS: There was no statistically significant difference in age, stone size, operative duration or hospital stay between the groups (P > 0.05). Furthermore, there was no statistical difference in flank pain or urinary symptoms (P > 0.05), except haematuria, between the groups; haematuria was more severe and prolonged in the stented group (P = 0.001). CONCLUSIONS: Uncomplicated ureteroscopy for removing calculi is safe with no stent after treatment, and after considering complications and side-effects we think that the routine use of ureteric stents after uncomplicated ureteroscopy for stone extraction is unnecessary.