Breau R H, Norman R W
Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada.
J Urol. 2001 Sep;166(3):890-3.
We evaluated issues associated with proximal ureteral stent migration and remigration, including causes and management, and the predictability of ureteral length.
All proximal ureteral stent migrations that occurred from January 1997 to March 2000 were reviewed. Characteristics and treatment of the 33 patients with proximal ureteral stent migration were compared with those of 66 randomly selected controls who did not have stent migration. We also analyzed a subgroup of 6 cases of remigration.
Of the ureteral stents 2% migrated proximally. Mean height was greater in patients with versus without a migrated stent (p = 0.028). The stent-to-ureter length ratio was lower in the migrated than in the nonmigrated group (p <0.0001). Patient height and side of migration were significant predictors of ureteral length (R2 = 0.3511, p <0.0001 and 0.0007, respectively). Of the patients who required continued ureteral stenting migrated stent management included placement of a longer stent in 9 (group 1) and a stent of equal length in 4 (group 2), and repositioning of the original stent in 4 (group 3). There was no remigration in group 1. However, migration recurred in 2 patients in group 2 (50%) and in all 4 in group 3 (100%).
Proximal migration occurs when a stent is too short for the ureter. We recommend that ureteral length should be measured directly from an x-ray to select the optimal stent length. If it is necessary to continue stenting a ureter after migration has been detected, a longer stent should be placed.
我们评估了与近端输尿管支架移位和再移位相关的问题，包括原因、处理方法以及输尿管长度的可预测性。
回顾了1997年1月至2000年3月期间发生的所有近端输尿管支架移位情况。将33例近端输尿管支架移位患者的特征和治疗方法与66例随机选择的未发生支架移位的对照患者进行比较。我们还分析了6例再移位患者的亚组情况。
输尿管支架近端移位的发生率为2%。发生支架移位的患者平均身高高于未发生移位的患者（p = 0.028）。移位组的支架与输尿管长度比低于未移位组（p <0.0001）。患者身高和移位侧是输尿管长度的重要预测因素（R2 = 0.3511，p分别<0.0001和0.0007）。在需要继续进行输尿管支架置入的患者中，移位支架的处理方法包括：9例置入更长的支架（第1组），4例置入等长的支架（第2组），4例重新放置原支架（第3组）。第1组未发生再移位。然而，第2组有2例患者（50%）再次发生移位，第3组的4例患者均（100%）再次发生移位。
当支架对于输尿管来说太短时会发生近端移位。我们建议应通过X线直接测量输尿管长度以选择最佳的支架长度。如果在检测到移位后仍有必要继续对输尿管进行支架置入，应置入更长的支架。
