Choi Eugene K, Song Ho-Young, Shin Ji Hoon, Lim Jin-Oh, Park Hyungkeun, Kim Choung-Soo
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2 Dong, Songpa-Gu, 138-736 Seoul, Korea.
AJR Am J Roentgenol. 2007 Dec;189(6):1517-22. doi: 10.2214/AJR.07.2149.
The purpose of this study was to evaluate the long-term clinical efficacy of temporary placement of covered retrievable stents in the management of recurrent urethral strictures.
During the period December 1998-December 2005, 32 men and one adolescent boy (mean age, 48.6 years; range, 16-73 years) with recurrent urethral strictures underwent fluoroscopically guided insertion of a total of 68 stents. Patients without complications underwent elective stent removal 2 or 4 months after stent insertion. Rates of clinical success (long-term clinical and radiographic resolution of urethral strictures) were assessed. The Mann-Whitney U test was used to compare the duration of stent placement in patients with long-term clinical resolution with that in patients with stricture relapse.
Clinical success was achieved in 18 (55%) of the 33 patients. The mean duration of stent placement in patients with clinical success was significantly different from that in patients who had recurrences (p < 0.0001). Stricture relapse did not occur in only four (20%) of 20 cases of stent placement for 2 months. All 14 stent placements lasting at least 4 months resulted in long-term resolution after a mean follow-up period of 3.6 years. The most common complications necessitating early stent removal were stent migration (33.8% of stents) and tissue hyperplasia (20.6% of stents).
Placement of a covered retrievable stent for a minimum of 4 months is effective in inducing long-term resolution of refractory urethral strictures. Stent migration remains the largest obstacle in achieving adequate duration of stent placement.
本研究旨在评估临时性置入可回收覆膜支架治疗复发性尿道狭窄的长期临床疗效。
1998年12月至2005年12月期间，32名男性和1名青少年男性（平均年龄48.6岁；范围16 - 73岁）患有复发性尿道狭窄，在透视引导下共置入68枚支架。无并发症的患者在支架置入后2或4个月进行择期支架取出。评估临床成功率（尿道狭窄的长期临床和影像学缓解情况）。采用Mann-Whitney U检验比较长期临床缓解患者与狭窄复发患者的支架置入持续时间。
33例患者中有18例（55%）取得临床成功。临床成功患者的支架置入平均持续时间与复发患者的显著不同（p < 0.0001）。20例支架置入2个月的病例中仅有4例（20%）未发生狭窄复发。所有14例支架置入至少4个月的患者在平均3.6年的随访期后均实现了长期缓解。需要早期取出支架的最常见并发症是支架移位（占支架的33.8%）和组织增生（占支架的20.6%）。
置入可回收覆膜支架至少4个月可有效诱导难治性尿道狭窄的长期缓解。支架移位仍然是实现足够支架置入持续时间的最大障碍。
