Singh V, Srinivastava A, Kapoor R, Kumar A
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, India.
Int Urol Nephrol. 2005;37(3):541-6. doi: 10.1007/s11255-004-4704-6.
The forgotten ureteral stents remain a urological dilemma and complications related to it can be lethal for the patient. The management of such stents require lithotripsy and endourological techniques.
We retrospectively reviewed the records of 19 cases of forgotten stents managed between 1998 and 2003. The mean patient age was 32 +/- l2 years, male to female ratio 17:2 and the mean duration of stents in urinary system was 24.2 months (7 months to l0 years). The stent were complicated in 14 patients and 5 patients had uncomplicated stents. The stents were severely calcified and encrusted in 6 patients, large stone formation seen at upper end of stent in 2 patients and at lower end of stents in 2 patients. The stents were spontaneously fragmented in 2 patients. The advanced renal failure secondary to hydroureteronephrosis because of severe encrustation and stone formation over the stent in solitary kidney was seen in 1 patient and 1 patient had upmigrated stent with infected hydronephrosis, but the duration of upmigration in this case was unknown.
The stents were removed by retrograde approach in all 5 uncomplicated cases. In 6 patients of severely calcified and encrusted stents, the retrograde stent removal could be done in 4 patients while stent got broken in proximal ureter in 2 cases when they were being removed. In these 2 cases the stents were removed by percutaneous nephrostomy. The percutaneous nephrolithotomy and stent removal was done in 2 patients who had large stone at the upper end of stent in renal pelvis. In 2 patients who had large stone formation at lower end, stones were fragmented by mechanical lithotripsy in one and by laser lithotripsy in another case and stents removed by retrograde approach. Two cases of spontaneous fragmented stents were managed by retrograde endoscopic approach. The patient of advanced renal failure refused treatment and died. The patient of infective hydronephrosis with upmigrated stent died because of complications related to operative intervention.
The management of complicated forgotten ureteral stents need judicious use of endourological techniques and lithotripsy. The stent related complication can be directly lethal for the patient or indirectly can cause death because of complications related to operative intervention.
被遗忘的输尿管支架仍然是泌尿外科的一个难题,与之相关的并发症可能对患者致命。此类支架的处理需要采用碎石术和腔内泌尿外科技术。
我们回顾性分析了1998年至2003年间处理的19例被遗忘支架的病例记录。患者平均年龄为32±12岁,男女比例为17:2,支架在泌尿系统中的平均留置时间为24.2个月(7个月至10年)。14例患者的支架出现并发症,5例患者的支架未出现并发症。6例患者的支架严重钙化并结壳,2例患者在肾盂内支架上端见大结石形成,2例患者在支架下端见大结石形成。2例患者的支架自发断裂。1例孤立肾患者因支架严重结壳和结石形成导致输尿管肾积水继发晚期肾衰竭,1例患者支架上移并伴有感染性肾积水,但该例上移时间不详。
5例无并发症的病例均通过逆行途径取出支架。6例支架严重钙化并结壳的患者中,4例通过逆行途径取出支架,2例在取出时支架在输尿管近端断裂。这2例患者通过经皮肾造瘘取出支架。2例肾盂内支架上端有大结石的患者行经皮肾镜取石并取出支架。2例支架下端有大结石形成的患者,1例通过机械碎石术碎石,另1例通过激光碎石术碎石,然后通过逆行途径取出支架。2例支架自发断裂的病例通过逆行内镜途径处理。晚期肾衰竭患者拒绝治疗死亡。支架上移并伴有感染性肾积水的患者因手术干预相关并发症死亡。
处理复杂的被遗忘输尿管支架需要明智地运用腔内泌尿外科技术和碎石术。支架相关并发症可能直接导致患者死亡,或因手术干预相关并发症间接导致死亡。