Dauw Casey A, Faerber Gary J, Hollingsworth John M, Wolf J Stuart
Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Can J Urol. 2015 Jun;22(3):7806-10.
Ureteral obstruction due to extrinsic compression is associated with significant morbidity and mortality. Management options for this condition include renal drainage with percutaneous nephrostomy (PCN) or internal ureteral stent placement. A significant portion of patients will have disease progression leading to internal stent obstruction which is almost uniformly managed with PCN. We evaluated a novel, wire-reinforced internal ureteral stent as an alternative to PCN in those patients who fail initial internal ureteral stent placement.
A retrospective chart review was performed to identify patients with extrinsic ureteral obstruction that failed conventional plastic internal ureteral stent placement and ultimately underwent placement of wire-reinforced internal ureteral stents (Scaffold) at the University of Michigan Health System between 2006-2011. Outcomes assessed included time to Scaffold stent failure and failure free time with Scaffold stent in place.
A total of 8 patients were identified with extrinsic ureteral obstruction that failed initial conventional ureteral stenting and had a Scaffold stent placed. Scaffold stents ultimately failed in 3 out of 8 patients. Mean time to Scaffold stent failure was 197 days (range 20-536). In the remaining 5 patients, mean failure-free time with Scaffold stents in place was 277 days (range 18-774).
Scaffold stent placement is a viable alternative to PCN in those patients with extrinsic ureteral obstruction who fail conventional internal ureteral stent placement.
外在压迫导致的输尿管梗阻与显著的发病率和死亡率相关。针对这种情况的治疗选择包括经皮肾造瘘术（PCN）进行肾引流或放置输尿管内支架。很大一部分患者会出现疾病进展，导致内支架梗阻，而这种情况几乎都通过PCN来处理。我们评估了一种新型的、带金属丝加强的输尿管内支架，作为那些初始输尿管内支架置入失败患者的PCN替代方案。
进行了一项回顾性病历审查，以确定2006年至2011年期间在密歇根大学卫生系统中，因外在输尿管梗阻而常规塑料输尿管内支架置入失败并最终接受带金属丝加强输尿管内支架（Scaffold）置入的患者。评估的结果包括Scaffold支架失败的时间以及Scaffold支架在位的无失败时间。
共确定8例因外在输尿管梗阻导致初始常规输尿管支架置入失败并置入了Scaffold支架的患者。8例患者中有3例Scaffold支架最终失败。Scaffold支架失败的平均时间为197天（范围20 - 536天）。在其余5例患者中，Scaffold支架在位的平均无失败时间为277天（范围18 - 774天）。
对于那些常规输尿管内支架置入失败的外在输尿管梗阻患者，Scaffold支架置入是PCN的一种可行替代方案。
