Soria Federico, Sun Fei, Durán Esther, Sánchez Francisco M, Usón Jesús
Endoscopy Department, College of Veterinary Medicine, University of Extremadura, Cáceres, Spain.
J Vasc Interv Radiol. 2005 Apr;16(4):521-9. doi: 10.1097/01.RVI.0000147074.74604.35.
To determine if the deployment of metallic ureteral stents in benign ureteral stricture is more effective than endoureterotomy.
Twenty pigs were randomly divided in two groups to be treated with endoureterotomy or metallic stents. The internal ureteral diameter 2 cm distal to the ureteropelvic junction, histopathologic changes, ultrasonographic and fluoroscopic studies, urine culture, and serum urea and creatinine levels were analyzed during the phases of the study. The study was divided into three phases. The first included premodel documentation of normal urinary tract and laparoscopic ureteral stricture induction. In the second phase 1 month later, diagnosis and endoureteral treatment were carried out. Twelve weeks after stricture treatment, follow-up imaging studies and postmortem evaluation of all animals were performed.
The success rates were 80% for endoureterotomy and 70% for metallic stent implantation. In all animals in the latter group, a ureteral hyperplasic reaction took place that affected the zone of stent implantation. One difference between the groups was the presence of urinary infection in 30% of animals in the endoureterotomy group and in no animals treated with metallic stents. Statistically significant differences in ureteral diameter between the first and second study phases were found within both groups (P < .0001), but not between groups (P = .021). Results from pathologic analysis revealed statistically significant differences between groups (P = .0029).
The interaction among the distal end of the metallic stent, the urothelium, and peristalsis might be the origin of the failure of these devices. Although the deployment of metallic stents is attractive compared with other endourologic techniques like endoureterotomy in cases of benign strictures, certain problems must be resolved to prevent hyperplasia. Until then, this technique will not be a fully reliable therapeutic option for ureteral disorders.
确定在良性输尿管狭窄中植入金属输尿管支架是否比输尿管内切开术更有效。
将20头猪随机分为两组，分别接受输尿管内切开术或金属支架治疗。在研究阶段分析肾盂输尿管连接处远端2 cm处的输尿管内径、组织病理学变化、超声和荧光镜检查、尿培养以及血清尿素和肌酐水平。该研究分为三个阶段。第一阶段包括正常尿路的术前记录和腹腔镜输尿管狭窄诱导。1个月后的第二阶段进行诊断和输尿管内治疗。狭窄治疗12周后，对所有动物进行随访影像学检查和尸检评估。
输尿管内切开术的成功率为80%，金属支架植入的成功率为70%。在后一组的所有动物中，均发生了影响支架植入区域的输尿管增生反应。两组之间的一个差异是，输尿管内切开术组30%的动物存在尿路感染，而接受金属支架治疗的动物中没有。两组在研究的第一阶段和第二阶段之间输尿管直径存在统计学显著差异（P <.0001），但组间无差异（P =.021）。病理分析结果显示组间存在统计学显著差异（P =.0029）。
金属支架远端、尿路上皮和蠕动之间的相互作用可能是这些装置失效的原因。尽管在良性狭窄病例中，与输尿管内切开术等其他腔内泌尿外科技术相比，植入金属支架具有吸引力，但必须解决某些问题以防止增生。在此之前，该技术对于输尿管疾病不会是一种完全可靠的治疗选择。
