Department of Urology, Cairo University Hospitals, Cairo, Egypt.
J Endourol. 2010 Apr;24(4):551-5. doi: 10.1089/end.2009.0427.
The objective of this study was to compare the results of antegrade (AG) ureteral stenting with retrograde (RG) stenting during laparoscopic dismembered pyeloplasty.
Between October 2003 and April 2007, a case series of 47 laparoscopic dismembered pyeloplasties were done by three surgeons of equal expertise in laparoscopic surgery, where the Double-J ureteral stent was placed by the RG method (RG stenting group) in 15 cases and by the AG method (AG stenting group) in 32 patients. Intraoperative findings and operative data were recorded. Clinical and radiological outcomes were evaluated during the follow-up visits at 3, 6, 12 months and then annually.
Differences in patient's age and body mass index were not statistically significant. Laparoscopic pyeloplasty was successfully completed in 45 patients, with two cases of conversion to open (one in each group). A crossing vessel was identified in 42% of RG stenting group versus 45% of AG stenting group. A state of high ureteral insertion was identified in 16% of AG stenting group, a finding that was never seen in RG stenting group. Mean operative time was 271 +/- 21 minutes for RG stenting group versus 199 +/- 34 minutes for AG stenting group, a difference that was statistically significant (p <or= 0.01). Differences in estimated blood loss, hemoglobin decline, time to oral feeding, duration of urethral catheter, and length of hospital stay were not significant. Postoperative complications were seen in two patients: postoperative hematuria belonging to RG stenting group was managed endoscopically and prolonged urine leakage belonging to AG stenting group ceased spontaneously by postoperative day 8. Clinical and radiological improvement was evident in 97%, with a mean follow-up of 30 +/- 17 months.
AG ureteral stenting is technically feasible and provides better dissection, especially in patients with high ureteral insertion and secondary ureteropelvic junction obstruction, with good long-term outcome in both groups.
本研究旨在比较经腹腔镜离断肾盂成形术中顺行（AG）与逆行（RG）输尿管支架置入的效果。
2003 年 10 月至 2007 年 4 月，由 3 位经验相当的腹腔镜手术专家完成了 47 例腹腔镜离断肾盂成形术，其中 15 例采用 RG 法（RG 置管组）放置双 J 输尿管支架，32 例采用 AG 法（AG 置管组）。记录术中所见和手术数据。在随访中，于术后 3、6、12 个月及以后每年评估临床和影像学结果。
患者年龄和体重指数的差异无统计学意义。45 例患者成功完成腹腔镜肾盂成形术，其中 2 例（每组各 1 例）转为开放性手术。RG 置管组 42%有交叉血管，AG 置管组 45%有交叉血管。AG 置管组 16%有高位输尿管插入，而 RG 置管组从未发现。RG 置管组的平均手术时间为 271±21 分钟，AG 置管组为 199±34 分钟，差异有统计学意义（p≤0.01）。估计出血量、血红蛋白下降、开始口服饮食时间、导尿管留置时间和住院时间的差异无统计学意义。术后并发症见于 2 例患者：RG 置管组为术后血尿，行内镜处理；AG 置管组为术后第 8 天自发停止的延长性尿漏。97%的患者临床和影像学改善明显，平均随访 30±17 个月。
AG 输尿管支架置入技术上可行，并可提供更好的分离，特别是在高位输尿管插入和继发性肾盂输尿管连接部梗阻的患者中，两组均有良好的长期效果。
