肾移植术后短期留置双J管的疗效观察

目的:探讨肾移植术短期置放双J管的作用.方法:将142例肾移植患者按留置双J管时间随机均分短期(7天)组与常规(1个月)组,两组患者年龄、性别、以前接受移植的次数、免疫抑制剂的使用、急性肾小管坏死发生率上相似;患者均采用膀胱外输尿管膀胱吻合.结果:两组患者各出现1例输尿管坏死尿瘘,均无输尿管梗阻发生;两组患者泌尿系感染发生率无明显差异.结论:肾移植手术短期留置双J管安全、可靠,与常规留置1个月者疗效无明显差异.     

脑死亡后器官捐献肾移植术后泌尿系感染危险因素的单中心临床研究

目的 探讨脑死亡后器官捐献肾移植术后受者发生泌尿系感染的独立危险因素，为受者泌尿道感染制定相应预防和控制措施提供理论依据。方法 回顾性分析2021年1月—2021年12月于北部战区总医院器官移植中心行同种异体的100例肾移植患者的临床资料，根据患者术后3个月内是否发生泌尿系感染分为感染组(26例)和非感染组(74例),采用单因素和多因素分析寻找脑死亡后器官捐献肾移植术后受者发生泌尿系感染的影响因素。结果 肾移植术后3个月内泌尿系感染的发生率为26%(26例)。单因素分析结果显示：性别、术后尿瘘、术后尿管留置时间及术后双J管留置时间是脑死亡后器官捐献肾移植术后受者泌尿系感染的影响因素(P<0.05);运用前进法逐步回归分析得出，术后双J管留置时间(OR=1.086,95%CI:1.003～1.177,P=0.042)及术后尿管留置时间(OR=4.687,95%CI:2.064～10.645,P<0.010)。是脑死亡后器官捐献肾移植术后受者出现泌尿系感染的独立危险因素(P<0.05)。结论 术后尿管留置及术后双J管留置时间长会增加脑死亡后器官捐献肾移植术后受者发生泌尿系...     

经输尿管镜钬激光碎石术后留置双J管的临床研究

目的 探讨经输尿管镜钬激光治疗输尿管结石术后留置双J管的适应证及其必要性.方法 按病例纳入标准将270例输尿管结石患者随机分成A和B两组,经输尿管镜钬激光碎石术后,A组(135例)不留置双J管,B组(135例)放置双J管4周,比较两组之间的手术时间,术后腰腹部疼痛评分(VAS)、血尿、 尿路感染、膀胱刺激症状及远期输尿管狭窄发生率.结果 A组手术时间较B 组缩短(P<0.05),术后1、3d A组患者腰痛VAS评分与B组比较差异无统计学意义,而术后第7、14天 A组患者腰痛 VAS评分及血尿发生率均明显低于B 组(P<0.01).术后A组患者膀胱刺激症状明显低于B 组(P<0.01),两组尿路感染率差异无统计学意义.术后3个月两组均未出现输尿管狭窄并发症.结论 对于不复杂的输尿管结石,特别是单纯输尿管中下段结石常规放置双J管是不必要的.     

对无管化输尿管镜碎石取石术的探讨

目的 探讨输尿管镜碎石取石术处理简单输尿管下段结石后不留置双J管与尿管的初步经验.方法 回顾性分析从2009年1月至2012年10月对64例简单输尿管下段结石患者行输尿管镜碎石取石术的临床资料,患者被分为两组:对照组32例(放置双J管);观察组32例(不放置双J管与尿管).结果 放置双J管组手术时间显著长于无管化组;无管化组术后患者腰痛、血尿、膀胱刺激征的发生率低于放置双J管组,两组之间有显著性差异(P＜0.05);术后1个月输尿管无石率无统计学差异(P＞0.05).结论 输尿管镜碎石取石术治疗简单输尿管下段结石,可不必常规留置双J管与尿管,创伤轻,痛苦少,恢复快.     

输尿管镜钬激光碎石术后双J管留置时间与并发症的回顾性研究

目的探讨输尿管镜钬激光碎石术后支架管留置时间与并发症的关系。方法将由2017年1月1日至2019年8月1日264例患者根据留置支架管时间不同进行分组,留置时间2周的患者为2周组,留置时间为1个月的患者为4周组,回顾性分析支架管留置时间与相关并发症发生率的关系。结果拔除输尿管支架管前:2周组患者输尿管支架症状问卷(USSQ)评分及生活质量评分及双J管表面结石形成的发生率均低于4周组,差异有统计学意义(P0.05),而两组间尿路感染、双J管异位、结石清除率等方面差异无统计学意义(P0.05)。拔除支架管1周后:两组之间USSQ评分及生活质量指数评分方面差异无统计学意义(P0.05)。结论输尿管镜钬激光碎石术后缩短支架管留置时间可减少术后下尿路症状、身体疼痛情况、双J管表面结石形成等并发症的发生并提高生活质量,且对结石清除率并无明显影响。     

双J管在体外冲击波碎石联合物理振动排石治疗肾下盏结石中的应用

目的:探讨留置双J管后行体外冲击波碎石(ESWL)联合物理振动排石(EPVL)治疗肾下盏结石的疗效。方法:入组65例单纯肾下盏结石患者,其中将留置双J管后行ESWL联合EPVL治疗的32例患者作为试验组,同期未留置双J管行ESWL联合EPVL治疗的33例患者作为对照组。比较两组患者基本资料、当日见石率、2周结石排净率及治疗过程中相关并发症等情况。结果:试验组当日见石率、2周结石排净率明显高于对照组,差异有统计学意义(P<0.05)。治疗过程中试验组肉眼血尿发生率明显高于对照组,而肾绞痛发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:留置双J管后行ESWL联合EPVL治疗直径相对较大的肾下盏结石,能有效增加结石排净率,缩短结石排净时间,降低患者肾绞痛发生率,减轻患者痛苦。     

集尿引流装置对预防留置尿管相关性尿路感染有效性的Meta分析

目的评价留置尿管期间,采用不同集尿引流装置对预防留置尿管相关性尿路感染的影响,为临床规范化应用集尿引流装置提供循证依据。方法计算机检索Medline、Embase、CBMdisc等数据库中关于留置导尿患者应用不同集尿引流装置对预防留置尿管相关性尿路感染的影响的临床随机对照试验(RCT),对所得文献进行系统复习及评价,比较应用简单式密闭引流装置与复杂式密闭引流装置对预防留置尿管相关性尿路感染的影响。结果共纳入了4个随机对照试验。4个研究的Meta分析结果显示,简单式密闭引流装置与复杂式密闭引流装置比较,两者在尿路感染发生率方面的差异无统计学意义(OR:1.19,95%CI:0.75～4.49)。但两者对集尿袋内细菌产生时间的影响有统计学差异(OR:4.60,95%CI:3.14～6.06)。结论留置导尿患者使用复杂式密闭引流装置不仅不能降低尿路感染的发生率,而且将加快留置导尿患者膀胱内细菌产生的时间。     

术前留置双J管时间对经输尿管软镜治疗肾结石的疗效影响

目的:研究留置双J管时间对肾结石患者行输尿管软镜治疗(RIRS)清石率、并发症及患者疼痛的影响。方法:选取2015年9月～2018年9月我院肾结石患者152例进行前瞻性研究,采用随机数字表法均分为两组各76例,均采用RIRS进行治疗,术前常规留置双J管,观察组留置时间为1周,对照组为2周,比较两组手术时间、住院时间、术后3d及1个月结石清除率、术后疼痛、输尿管壁损伤以及其他并发症发生情况。结果:观察组手术时间高于对照组,差异有统计学意义(P0.05),两组术后3 d结石清除率分别为71.05%和65.79%(P0.05),术后1个月结石清除率分别为97.37%和93.42%(P0.05);两组住院时间、术后疼痛及输尿管壁损伤差异无统计学意义(P0.05);观察组术后发热及尿源性脓毒症发生率低于对照组,结石残留、血尿和输尿管损伤发生率高于对照组,差异均无统计学意义(P0.05)。结论:RIRS术前常规留置双J管1周可导致较大结石手术时间较留置2周时明显延长,但对结石清除率和并发症发生率均未产生明显影响,因此临床根据患者病情合理缩短双J管留置时间具有一定可行性。     

肺癌患者围手术期无痛性留置导尿管的前瞻性队列研究

目的探讨肺叶切除术中在麻醉状态下(无痛性)留置尿管临床应用效果和优势。方法前瞻性纳入2014年4~12月在四川大学华西医院胸外科单个医疗组行肺癌肺叶切除术患者133例。根据手术结束患者麻醉苏醒前是否留置尿管留将患者分为对照组(68例,常规留置尿管)和试验组(65例,不留置尿管)。比较两组患者临床效果。结果对照组全身麻醉苏醒后诉尿道刺激和苏醒期躁动发生率(13.24%,26.47%)均高于试验组(3.08%,10.77%),且差异有统计学意义(P=0.041,P=0.022)。试验组术后尿潴留发生率(10.77%)与对照组(4.41%)的差异无统计学意义(P=0.403);试验组术后尿道感染发生率(9.23%)低于对照组(26.47%),差异有统计学意义(P=0.047)。试验组术后舒适度(0度,87.69%)优于对照组(48.53%),差异有统计学意义(P=0.001)。试验组术后平均住院时间(5.00±1.60)d短于对照组(6.48±3.14)d,差异有统计学意义(P=0.004)。结论肺癌围手术期无痛性尿管留置有助于改善患者的住院舒适度并促进快速康复。     

肾移植手术常规置放双J管的作用

目的:探讨肾移植手术常规置放双J管的作用。方法:将230例下尿路功能正常的肾移植患者随机分为常规置放双J管组与未置放双J管组,所有患者均采用膀胱外法作输尿管膀胱吻合。结果:两组在年龄、性别、接受移植的次数、免疫抑制剂的使用、急性肾小管坏死的发生率上相似,常规置放双J管组输尿管并发症总发生率明显低于未置放双J管组(P<0.05),在尿瘘和输尿管梗阻发生率上,常规置放双J管组也明显低于未置放双J管组(P<0.05,P<0.01)。结论:肾移植手术常规置放双J管可以明显降低术后输尿管并发症。     

输尿管镜钬激光碎石术后双J管相关并发症的危险因素

目的探讨输尿管镜钬激光碎石术后双J管相关并发症的危险因素。方法于2009年3月至2010年12月前瞻性持续纳入病例,对可能引起并发症的因素进行单因素和多因素统计分析。结果纳入257例患者,术后并发症的发生率为83.2%。多因素分析显示,尿路刺激症的危险因素为双J管远端经过膀胱中线、留置26 cm双J管、双J管留置超过4周;排尿困难的危险因素为留置26 cm双J管;腰痛的危险因素为留置24、26 cm双J管。镜下血尿的危险因素为留置26 cm双J管、留置超过4周;急性尿失禁的危险因素为双J管远端经过膀胱中线。结论多数并发症与双J管长度过长有关。选择合适长度的双J管可能是减少术后相关并发症最重要的因素。     

A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin

OBJECTIVE: To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS: Patients across specialities with a urethral catheter in situ for >/= 48 h and 相似文献   

Urinary tract infections in kidney transplant recipients.

In 65 kidney transplant recipients who were followed up for a mean period of 14.7 months, the incidence of urinary tract infection (UTI), and how the incidence was affected by length of graft survival, age, HLA-A and HLA-B matches, complications, duration of Foley catheter use, and other aspects, were examined. The total incidence of infection included an unexpectedly high rate of late infections. The incidence was found to be statistically increased with nephrectomy, splenectomy, recatheterization, and age older than 40 years. There was no correlation noted with graft source, antigen match, graft loss, or previous history of UTI. A group of patients with persistent UTI was noted and an inability to suppress UTI with long-term therapy with antibiotics was found. The asymptomatic nature of most of the UTIs confirmed the need for frequent periodic cultures of urine in the immunosuppressed patient.     

Comparison of nitinol urethral stent infections with indwelling catheter-associated urinary-tract infections

BACKGROUND AND PURPOSE: To determine the efficacy of intraurethral metal stents in preventing or eradicating urinary-tract infections (UTI) during the management of bladder outlet obstruction (BOO) by comparing the frequency and nature of the infections with indwelling-catheter-associated UTI. PATIENTS AND METHODS: The SAS relative-risk test was used to compare the risks of UTI in 76 patients with temporary urethral stents, 60 patients with BOO who had never been catheterized nor stented, and 34 patients with a permanent indwelling urethral catheter (PIUC). Infection was assessed 1 month after placement of the devices. Scanning electron microscopy (SEM) of the proximal and distal pieces of the stents removed from five patients with and five patients without UTI was carried out in a search for predisposing changes on the surfaces. RESULTS: After insertion of the catheter, UTI developed in 79.4% of the patients who originally had sterile urine. However, after insertion of the stent, UTI developed in only 40.9% of the patients with sterile urine. In 21 (44.6%) of the catheterized patients who had infected urine, UTI was eradicated after stent insertion. The SEM analysis of the stents showed that a thick organic layer had formed only on the infected devices but with no sign of erosion. CONCLUSION: Urinary infection is a significant problem in patients with PIUC but is significantly less frequent and less severe in patients with urethral stents. This advantage of stents over the conventional urethral catheter, in addition to their obvious convenience for the patient, make them good alternatives to reduce the risk of UTI.     

Immediate postoperative morbidity in patients with indwelling double-J stent versus overnight-externalized ureteral catheter after tubeless percutaneous nephrolithotomy: a prospective, randomized study

The conventional technique for percutaneous nephrolithotomy (PNL) ends by placing a nephrostomy tube within the access tract. However, feasibility and safety of tubeless PNL have been widely demonstrated. In this modification, a ureteral stent is usually left in place instead of the nephrostomy tube. The aim of this study is to compare the use of a postoperative indwelling double-J stent versus an overnight-externalized ureteral catheter in patients undergoing tubeless PNL. Sixty-eight patients undergoing tubeless PNL were randomized either for a postoperative double-J stent (group 1) or for an overnight-externalized ureteral catheter (group 2). Outcomes evaluated included postoperative pain, hospital stay length, incidence of hemorrhagic complications, residual lithiasis and urinary leakage. Groups were similar according to age, sex, body mass index and stone burden. There were no significant differences in terms of postoperative pain, incidence of perirenal hematomas, residual lithiasis and urinary leakage. However, patients in group 1 presented longer hospital stays (3.7 ± 1.7 vs. 1.9 ± 0.3 days; p < 0.001) and greater hematocrit drops (4.9 ± 2.2 vs. 2.1 ± 1.8 %; p < 0.001). Our results confirm that among patients undergoing tubeless PNL, both alternatives (i.e. leaving a double-J stent or an overnight-externalized ureteral catheter) are reliable and safe. However, further considerations, like the need of double-J stent removal under cystoscopy, need to be taken into account when deciding which modality to use.     

改良导尿管在尿道成形术患儿中的应用

目的 探讨改良导尿管对小儿尿道成形术后引流尿液,缓解患儿排尿疼痛,减少术后并发症的作用.方法 将120例尿道成形术后患儿随机均分为两组.对照组按常规方法,在新成形尿道内置一管径8～10F的多侧孔短硅胶支架管.观察组则应用8～12F改良导尿管引流尿液,即在导尿管中、下段剪多个侧孔,持续导尿10 d左右后将改良导尿管中段多侧孔段下移至新建尿道处作为短支架管,指导患儿自控排尿.结果 观察组术后排尿疼痛评分显著低于对照组,术后并发症发生率显著低于对照组(均P＜0.01);两组术后尿培养均为阴性,无尿路逆行感染.结论 应用改良导尿管引流尿液能有效缓解小儿尿道成形术后排尿疼痛,减少手术并发症.     

The applicability of using straight ureteral stents for the treatment of ureteral stones in presumably non-compliant patients

There have been many reports describing the complications of retained ureteral stents following stone treatment. We wanted to evaluate the practicality of definitive treatment of poorly compliant patients who present with ureteral stones using a straight stent connected to a urethral catheter alone and compared these to patients treated with double-J stents alone. We treated 23 patients (12 in group I and 11 patients in group II) who had a ureteral stone of 6 mm or less, with an indwelling straight stent and a double-J stent, respectively, while on oral antibiotics. We followed these patients 1 week later with an abdominal X-ray prior to removing the stent. Eleven patients in group I and 9 patients in group II passed their stones spontaneously. Three patients required surgical intervention with a ureterscope and laser lithotripsy. There were no cases of infection or pyelonephritis. Although each of the straight-stent-treated patients returned to our clinic for follow-up, only 5 of the 11 double-J stent patients returned for follow-up. The remaining 6 patients had to be contacted to remind them that they still had an internal stent. Although technologic advances now allow many urologists to definitively treat ureteral stones, some urologists may lack the proper equipment and/or assistance to treat the stone at the time of presentation, or may deal with non-compliant patients. Therefore, in these certain circumstances, treatment of small ureteral stones in non-compliant patients using a straight stent connected to a leg bag, as either definitive or initial treatment, may be of practical use and avoid the risk of retained double-J ureteral stents.     

异种膀胱无细胞基质替代尿道的研究

目的探讨异种膀胱无细胞基质(ACM)管状替代尿道的可行性。方法19只成年雄性新西兰白兔分成3组：A组3只，为假手术对照组；B组10只，切除一段1．0cm尿道；C组6只，切除一段3．5～4．0cm尿道，之后应用已经事先制备好的异种膀胱ACM制成相当长度的管状替代被切除的尿道。术后1、2、4、8、16周动态观察替代尿道的尿道上皮、平滑肌和血管的再生情况。结果所有实验动物在术后7d拔除尿管后都恢复了自主排尿，没有排斥、尿瘘、感染等并发症发生。组织学检查显示实验组术后2周尿道上皮再生良好，4周完全覆盖尿道内腔，术后8周平滑肌见于近吻合口处，平滑肌生长缓慢，观察期内未能覆盖全长尿道。尿道造影未见明显尿道狭窄和憩室。结论异种膀胱ACM是一种良好的尿道修复和替代的材料。     

不同支架管留置时间对行经尿道输尿管镜取石术的泌尿系结石患者远期排石效果及安全性的影响

目的:探讨不同支架管留置时间对行经尿道输尿管镜取石术(URL)的泌尿系结石患者远期排石效果及安全性的影响。方法:选取2014年1月至2018年3月本院行URL的输尿管上段结石或肾结石患者共184例。按术后支架管留置时间差异分为两组,其中,术后支架管留置4周的96例患者为对照组;术后支架管留置2周的88例患者为观察组。比...     

Solifenacin improves double-J stent-related symptoms in both genders following uncomplicated ureteroscopic lithotripsy

The objective of this study is to evaluate the effects of solifenacin on double-J stent-related symptoms following uncomplicated ureterosocpic lithotripsy (URSL). A total of 70 patients who underwent double-J ureteral stent insertion following URSL were consecutively recruited and received solifenacin postoperatively. Another 70 age- and sex-matched subjects without solifenacin therapy were enrolled as a control group. The clinical data including stone and stent characteristics were collected. All subjects completed the brief-form Ureteral Symptom Score Questionnaire (Chinese-version) to assess the lower urinary tract symptoms, stent-related body pain and hematuria 2 weeks after operation. The severity of stent-related symptoms was compared between two groups. The mean age was 53.8 in solifenacin group and 53.4 years in the control group (p = 0.87). The stone characteristics, stent size, position and curl completeness were similar in both groups. Compared to the control group, solifenacin group had significantly lower total symptom score, urgency and urge incontinence scores. As for stent-related body pain, solifenacin group had significantly less flank, abdominal, urethral pain and hematuria scores (all p < 0.05). The solifenacin versus control group showed significant benefits in lower urinary tract symptoms, stent-related pain and hematuria in both genders (all p < 0.05). Four subjects encountered minor adverse events (5.7 %) and one had urinary retention (1.4 %) in solifenacin group. For patients undergoing URSL and double-J stent indwelling, postoperative solifenacin use was effective and well-tolerated for the treatment of lower urinary tract symptoms, stent-related body pain and hematuria irrespective of genders.