Zahran Mohamed H, Harraz Ahmed M, Taha Diaa-Eldin, El-Nahas Ahmed R, Elshal Ahmed, Shokeir Ahmed A
Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt .
J Endourol. 2015 Sep;29(9):1070-5. doi: 10.1089/end.2015.0047. Epub 2015 Apr 29.
To investigate the effect of missed internal ureteral stents (IUS) on renal function and to describe different modalities of management and associated morbidity.
A retrospective study included patients with missed IUS (>1 year). The complications of missed IUS were categorized according to the forgotten, encrusted, calcified (FECal) grading system. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation at time of initial stent placement and time of stent removal. An age- and sex-matched group of patients who had IUS and had available follow-up for the same duration of the study group were used as a control.
A total of 46 missed IUS in 46 patients were included. Complicated stents were reported in 34 (73.9%) patients. FECal grade 1 was reported in 16 (57.2%) patients followed by grade 2 and 4 in 5 (17.8%) patients each. Retrograde removal, visual cystolitholapaxy, ureteroscopy with laser disintegration of encrustations and combined retrograde and antegrade approach have been used in 21, 5, 10, and 9 patients, respectively. In the missed IUS group, the mean±standard deviation (SD) eGFR has declined from 65.5±26.3 mL/min/1.73m(2) to 54.3±30 mL/min/1.73m(2) (P=0.001). While in the control group, the mean±SD eGFR has increased from 57.5±30 mL/min/1.73 m(2) to 66.7±27 mL/min/1.73 m(2) (P=0.001).
Missed IUS were associated with significant complications that necessitated more invasive intervention. In addition, IUS had a negative impact on renal function at time of removal.
探讨输尿管内支架（IUS）遗漏对肾功能的影响，并描述不同的处理方式及相关并发症。
一项回顾性研究纳入了IUS遗漏（超过1年）的患者。根据遗忘、结痂、钙化（FECal）分级系统对IUS遗漏的并发症进行分类。在初次放置支架时和取出支架时，使用肾脏病饮食改良（MDRD）方程计算估计肾小球滤过率（eGFR）。将一组年龄和性别匹配、放置过IUS且随访时间与研究组相同的患者作为对照。
共纳入46例患者的46个遗漏IUS。34例（73.9%）患者的支架出现并发症。16例（57.2%）患者为FECal 1级，5例（17.8%）患者为2级和4级。分别有21例、5例、10例和9例患者采用了逆行取出、可视性膀胱碎石术、输尿管镜下激光清除结痂以及逆行和顺行联合方法。在遗漏IUS组中，平均±标准差（SD）的eGFR从65.5±26.3 mL/min/1.73m²降至54.3±30 mL/min/1.73m²（P = 0.001）。而在对照组中，平均±SD的eGFR从57.5±30 mL/min/1.73m²升至66.7±27 mL/min/1.73m²（P = 0.001）。
IUS遗漏与严重并发症相关，需要更具侵入性的干预。此外，取出IUS时对肾功能有负面影响。
