Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Urology. 2011 Jun;77(6):1299-303. doi: 10.1016/j.urology.2010.09.049. Epub 2010 Dec 24.
To evaluate the use of tandem double J stents in recalcitrant ureteral stenosis after kidney transplant.
We reviewed patients who underwent tandem double J stent placement after kidney transplant, assessing demographics (gender, age, cause of renal failure, recipient implantation site, blood pressure, donor status), renal function, biopsy results, site of stenosis, dilations, time with tandem stents, and outcome. Success was defined as ureteral patency without reconstructive surgery. Student t test was used for creatinine levels. Multivariate survival analysis identified risk factors for failure.
A total of 19 patients (mean age 36.6 years) were included. The most common site of ureteral stenosis was distal (79%). Average number of biopsies before tandem stents was 1.8 (0-5) and, pathology results showed acute rejection in 16%. Percutaneous nephrostomy was performed after 66.8 ± 140.8 weeks from transplantation date. Dilations averaged 2 ± 1.1 (0-4) before tandem placement. Renal function improved after tandem stents (P < .01) and remained stable throughout follow-up (P = .147). The patency success rate was 58% with a mean of 48.7 ± 48 weeks with tandem in place. The failure rate was 26%, with a mean of 16 ± 7 weeks for tandem time. No perioperative complications were identified. Number of dilations before tandem was the only factor associated with failure (hazard ratio = 2.61; confidence interval = 1.150-5.908, P < .03). Proximal strictures (P = .072) and renal function (P = .067) were associated with a trend for tandem stent failure.
Tandem stents can treat recurrent and recalcitrant ureteral stenosis after kidney transplantation that failed previous balloon dilation or ureteral reconstruction.
评估在肾移植后顽固输尿管狭窄中使用串联双 J 支架的效果。
我们回顾了肾移植后接受串联双 J 支架置入的患者，评估了人口统计学特征（性别、年龄、肾衰竭原因、受者植入部位、血压、供者状态）、肾功能、活检结果、狭窄部位、扩张次数、串联支架使用时间和结果。成功定义为输尿管通畅，无需重建手术。肌酐水平采用 Student t 检验。多因素生存分析确定了失败的危险因素。
共纳入 19 例患者（平均年龄 36.6 岁）。输尿管狭窄最常见的部位是远端（79%）。在放置串联支架之前，平均进行了 1.8 次（0-5 次）活检，病理学结果显示 16%为急性排斥反应。经皮肾造口术在移植日期后 66.8±140.8 周进行。在放置串联支架之前，扩张的平均值为 2±1.1（0-4 次）。放置串联支架后肾功能改善（P<0.01），并在整个随访期间保持稳定（P=0.147）。串联支架通畅的成功率为 58%，平均通畅时间为 48.7±48 周。失败率为 26%，串联支架使用时间的平均为 16±7 周。未发现围手术期并发症。放置串联支架前扩张次数是唯一与失败相关的因素（风险比=2.61；置信区间=1.150-5.908，P<0.03）。近端狭窄（P=0.072）和肾功能（P=0.067）与串联支架失败有趋势相关。
串联支架可治疗肾移植后复发和顽固的输尿管狭窄，这些狭窄先前经球囊扩张或输尿管重建治疗失败。
