Frattini A, Capocasale E, Granelli P, Mazzoni M P, Maestroni M P, Dalla Valle R, Salsi P, Busi N, Ferreri P, Cortellini P, Sianesi M
Urologia. 2007 Oct-Dec;74(4):212-6. doi: 10.5301/ru.2010.5887.
INTRODUCTION AND OBJECTIVES. Ureteral stenosis and vesicocoureteral reflux after renal transplantation represent a key concern because of their incidence and the associated morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed patients with single kidney. The aim of this study is to evaluate the success rate of the endourological techniques in the management of such complications. MATERIALS AND METHODS. Between January 1996 and December 2006, 647 kidney transplants were performed. Urinary tract continuity was re-established by ureteroneocystostomy according to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11 cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral stent placement in the other. Recipients with late stenosis underwent laser incision and balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case. Combined antegrade and retrograde endoscopic approach was performed in 7 patients, whereas retrograde access in 1. RESULTS. Endourologic treatment was successful in 9 cases (69.2%); 2 patients required open reconstructive surgery due to endourological technique failure (early ureteropelvic junction stricture, late ureterovesical anastomotic stricture). Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy for recurrent reflux. No technique-related morbidity was observed. With a mean follow- up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft). CONCLUSIONS. Considering their low morbidity and the satisfactory success rate, we claim that endourological procedures should be considered the preferred treatment for ureteral stenosis and vesicoureteric reflux in selected patients.
引言与目的。肾移植术后输尿管狭窄和膀胱输尿管反流因其发生率及相关发病率而成为关键问题。对于单肾免疫抑制患者，及时诊断和微创治疗至关重要。本研究旨在评估腔内泌尿外科技术处理此类并发症的成功率。材料与方法。1996年1月至2006年12月期间，共进行了647例肾移植手术。根据Gregoir-Lich技术通过输尿管膀胱吻合术重建尿路连续性。我们观察到13例输尿管狭窄（2%）和11例有症状的膀胱输尿管反流（1.7%）。对13例患者进行了腔内泌尿外科手术：5例Ⅱ - Ⅲ级膀胱输尿管反流、4例早期输尿管狭窄和4例晚期输尿管狭窄。膀胱输尿管反流患者中，4例行内镜下注射聚甲基丙烯酸甲酯，1例行内镜下注射Duraspheres。早期输尿管狭窄患者中，2例行球囊扩张，3例行球囊扩张联合激光输尿管内切开术，另1例行输尿管支架置入术。晚期狭窄患者中，2例行激光切开联合球囊扩张，1例行球囊扩张，最后1例仅行激光切开。7例患者采用顺行和逆行联合内镜入路，1例采用逆行入路。结果。腔内泌尿外科治疗9例成功（69.2%）；2例因腔内泌尿外科技术失败（早期肾盂输尿管连接部狭窄、晚期输尿管膀胱吻合口狭窄）需行开放重建手术。3例患者的膀胱输尿管反流得到纠正（60%），2例因反流复发而行输尿管输尿管吻合术。未观察到与技术相关的并发症。平均随访81.6个月，8例患者肾功能正常，5例患者恢复血液透析（4例因慢性排斥反应，1例因移植肾肿瘤）。结论。鉴于其低并发症发生率和令人满意的成功率，我们认为对于选定患者，腔内泌尿外科手术应被视为输尿管狭窄和膀胱输尿管反流的首选治疗方法。
