Morcillo Esther, Sánchez-Margallo Francisco Miguel, Serrano Alvaro, Fernández-Aparicio Tomas, Pamplona Manuel, Soria Federico
Investigadora de la Unidad de Endoscopia del Centro de Cirugía de Mínima Invasión Jesús Usón. Cáceres. Spain.
Director Científico del Centro de Cirugía de Mínima Invasión Jesús Usón. Cáceres. Spain.
Arch Esp Urol. 2015 Nov;68(9):701-9.
The purpose of this experimental study is to assess the additive effects of temporary JJ stent placement together with metal stents (MS) in the treatment obstructive uropathy, in order to reduce urothelial hyperplasia formation.
Twenty-four pigs were included, and an experimental model of obstructive uropathy was created. Six weeks after obstructive uropathy model induction, ureteral obstruction was confirmed using ultrasonography, ureteropyelography and endoluminal ultrasound. Afterwards, animals were randomly distributed into 2 groups. Group I underwent covered MS placement and JJ ureteral stenting for 3 weeks. Animals in Group II received the same MS without simultaneous JJ stenting. The follow-up was at 3 weeks and at 6 months.
Incidence of urothelial hyperplasia was higher in Group I than Group II, but without statically significant differences. On the other hand, Group II showed a significantly higher degree of obstruction severity due to hyperplasia. The migration rate in both groups was 33.3% at the end of the study. Significant differences were shown on animals showing urinary tract infection (UTI) and hyperplasia against those with hyperplasia but no infection. There was a high rate of correlation between UTI and obstructive urothelial hyperplasia.
Placement of JJ ureteral catheter does not inhibit urothelial hyperplasia associated with placement of metal mesh stents, although it significantly reduces its obstructive severity in long-term follow-up. Urinary tract infection is directly related to the development and magnitude of the urothelial hyperplasia.
本实验研究旨在评估临时置入双J支架与金属支架（MS）联合治疗梗阻性尿路病的附加效果，以减少尿路上皮增生的形成。
纳入24头猪，建立梗阻性尿路病实验模型。在诱导梗阻性尿路病模型6周后，使用超声、输尿管肾盂造影和腔内超声确认输尿管梗阻。之后，将动物随机分为2组。第一组接受覆膜MS置入和双J输尿管支架置入3周。第二组动物接受相同的MS，但不同时置入双J支架。随访时间为3周和6个月。
第一组尿路上皮增生的发生率高于第二组，但无统计学显著差异。另一方面，第二组由于增生导致的梗阻严重程度明显更高。研究结束时，两组的移位率均为33.3%。在出现尿路感染（UTI）的动物与有增生但无感染的动物之间，在增生方面显示出显著差异。UTI与梗阻性尿路上皮增生之间存在高度相关性。
置入双J输尿管导管虽在长期随访中显著降低其梗阻严重程度，但并不能抑制与金属网状支架置入相关的尿路上皮增生。尿路感染与尿路上皮增生的发生和程度直接相关。
