Ganatra Anjali M, Loughlin Kevin R
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Urol. 2005 Dec;174(6):2125-8. doi: 10.1097/01.ju.0000181807.56114.b7.
We developed an algorithm for the management of ureteral obstruction due to malignant extrinsic compression.
We retrospectively reviewed all ureteral stents placed for noncalculous reasons at our institution from January 1, 1990 to January 1, 2004. Further clinical information was gathered from 157 patients with malignant extrinsic ureteral compression. Failure was defined as recurrent ureteral obstruction or an inability to place stents cystoscopically.
A total of 157 patients underwent retrograde ureteral stent attempt for malignant extrinsic ureteral obstruction. Mean patient age was 54.7 years (range 23 to 83) and average followup was 13.6 months. Of our patients 61% were women, and the most common cancer diagnoses were ovarian cancer (in 26), lymphoma (17) and cervical cancer (16). A total of 24 patients required immediate percutaneous nephrostomy (PCN) referral. There were 32 patients who experienced a late failure and required PCN (average 180 days after initial stent), and 83 patients in our series (52.9%) who experienced 110 major complications. Type of cancer did not predict need for PCN. However, when invasion into the bladder was noted on cystoscopy, 55.9% (19 of 34, p = 0.008) progressed to PCN referral. A total of 77 patients underwent stent replacement on average 2.8 times and with an interval of 95 days.
In our series patients with malignant extrinsic ureteral compression presenting for ureteral stent(s) experienced a failure rate of 35.7% (56 of 157). Invasion at cystoscopy had a significant predictive value for progression to PCN. We present an algorithm on the management of extrinsic malignant ureteral obstruction.
我们开发了一种用于管理因恶性外部压迫导致的输尿管梗阻的算法。
我们回顾性分析了1990年1月1日至2004年1月1日在本机构因非结石原因放置的所有输尿管支架。从157例恶性外部输尿管压迫患者中收集了进一步的临床信息。失败定义为复发性输尿管梗阻或无法通过膀胱镜放置支架。
共有157例患者因恶性外部输尿管梗阻接受逆行输尿管支架置入尝试。患者平均年龄为54.7岁（范围23至83岁），平均随访时间为13.6个月。我们的患者中61%为女性，最常见的癌症诊断为卵巢癌（26例）、淋巴瘤（17例）和宫颈癌（16例）。共有24例患者需要立即转诊至经皮肾造瘘术（PCN）。有32例患者出现晚期失败并需要PCN（初始支架置入后平均180天），我们系列中的83例患者（52.9%）出现了110次主要并发症。癌症类型无法预测是否需要PCN。然而，膀胱镜检查发现侵犯膀胱时，55.9%（34例中的19例，p = 0.008）进展为转诊至PCN。共有77例患者平均进行了2.8次支架置换，间隔时间为95天。
在我们的系列中，因恶性外部输尿管压迫而接受输尿管支架置入的患者失败率为35.7%（157例中的56例）。膀胱镜检查时的侵犯对进展至PCN具有显著预测价值。我们提出了一种关于外部恶性输尿管梗阻管理的算法。
