Department of Urology, Division of Endourology and Stone Disease, University of Michigan, Ann Arbor, Michigan, USA.
J Endourol. 2011 Sep;25(9):1457-62. doi: 10.1089/end.2010.0647. Epub 2011 Jun 28.
Because of the high success of laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction, strategies for managing failures are less well described. We report our experience with persistent or recurrent obstruction after LP.
We reviewed 128 patients who were treated with LP at our institution from 1996 through 2008. Success was defined as objective resolution of obstruction by renal scintigraphy, Whitaker testing, or direct visualization. We extracted data by chart review regarding patient demographics, medical history, operative technique, and salvage treatments. We then assessed for association between patient characteristics and treatment failure.
Overall, 102 patients had sufficient follow-up, of which 84 (82%) were successes. Of 18 failures, median time to failure was 2.5 months (0.5-88 mos). Of 10 failures managed endoscopically, 7 were salvaged. One of two patients treated conservatively ultimately had resolution while six patients needed simple nephrectomy. Overall, 8 (44%) were salvageable with median follow-up of 19 months (4-58 mos). Patients with failure were more likely to have diabetes mellitus, longer length of stay, higher American Society of Anesthesiologists (ASA) score, a stent placed at the time of pyeloplasty, or ureteral stent malfunction (P<0.05). Patients with failure despite salvage were more likely to have stent malfunction or body mass index >30 kg/m(2) (P<0.05). Adjusting for the above factors, stent placement at time of surgery and ASA score >2 were associated with failure (P<0.05) while periureteral fibrosis trended toward a significant association (P=0.061).
Nearly half of failures after LP are salvageable, many with endoscopic management.
由于腹腔镜肾盂成形术（LP）治疗肾盂输尿管连接部梗阻的成功率很高，因此对于失败的治疗策略描述较少。我们报告了 LP 后持续性或复发性梗阻的经验。
我们回顾了 1996 年至 2008 年在我院接受 LP 治疗的 128 例患者。成功定义为肾闪烁扫描、惠特克测试或直接可视化客观解决梗阻。我们通过图表审查提取了有关患者人口统计学、病史、手术技术和抢救治疗的数据。然后评估患者特征与治疗失败之间的关系。
总体而言，有 102 例患者具有足够的随访，其中 84 例（82%）为成功。18 例失败中，中位失败时间为 2.5 个月（0.5-88 个月）。10 例内镜治疗失败中，7 例得到挽救。2 例保守治疗的患者最终得到缓解，而 6 例患者需要单纯肾切除术。总体而言，8 例（44%）可通过中位随访 19 个月（4-58 个月）挽救。失败患者更有可能患有糖尿病、住院时间更长、美国麻醉师协会（ASA）评分更高、肾盂成形术时放置支架或输尿管支架功能障碍（P<0.05）。尽管挽救失败的患者更有可能出现支架功能障碍或 BMI>30kg/m2（P<0.05）。调整上述因素后，手术时放置支架和 ASA 评分>2 与失败相关（P<0.05），而输尿管周围纤维化有显著相关性（P=0.061）。
LP 后近一半的失败是可挽救的，许多可通过内镜治疗。
