Zahran Mohamed H, Osman Yasser, Soltan Mohamed A, Abolazm Ahmed Elhussein, Ghazy Mostafa K, Harraz Ahmed M, Shokeir Ahmed A, Abol-Enein Hassan, Ali-El-Dein Bedeir
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Int Urol Nephrol. 2017 Aug;49(8):1327-1334. doi: 10.1007/s11255-017-1608-9. Epub 2017 May 13.
To evaluate the long-term renal function outcome of management of retroperitoneal fibrosis (RPF)-induced ureteral obstruction.
Thirty-six patients with idiopathic RPF-induced ureteral obstruction were classified according to the management type into two groups, group A; managed by indwelling JJ stent and group B managed by ureterolysis and omental wrapping (UOR). The primary outcome was to define the long-term outcome of management on RF. It was evaluated by changes in serum creatinine and estimated GFR (eGFR) using Modification of Diet in Renal Disease equation where 20% changes in eGFR is considered significant. The second outcome is to compare the outcomes between both groups.
After 27.5 (1-124) months, median (range) follow-up, median (range) serum creatinine increased significantly from 1.5 (0.8-8.1) to 1.6 (1-12.1) mg/dl (p value =0.04) and eGFR showed non-statistical significant reduction from 43 (5-110) to 41 (5-88) ml/min/1.73 m (p value =0.3). Eight (22.2%), 12 (34.4%) and 16 (44.4%) patients showed stable, increased and decreased eGFR. Group A showed statistically significant increased serum creatinine and insignificant decreased eGFR (p value =0.04 and 0.09), while group B showed statistically insignificant changes in serum creatinine and eGFR (p value =0.5 and 0.9). In group B, nine (21.4%) renal units are still harboring JJ stents.
For idiopathic RPF, UOR avoided indwelling ureteral stents in 78.6% of renal units with apparent better long-term renal function outcome.
评估腹膜后纤维化（RPF）所致输尿管梗阻治疗后的长期肾功能结局。
将36例特发性RPF所致输尿管梗阻患者根据治疗方式分为两组，A组采用留置双J管治疗，B组采用输尿管松解术及网膜包裹术（UOR）治疗。主要结局是确定RPF治疗的长期结局。通过使用肾脏病饮食改良方程计算血清肌酐和估计肾小球滤过率（eGFR）的变化来评估，其中eGFR变化20%被认为具有显著意义。第二个结局是比较两组之间的结局。
在中位（范围）随访27.5（1 - 124）个月后，中位（范围）血清肌酐从1.5（0.8 - 8.1）显著升高至1.6（1 - 12.1）mg/dl（p值 = 0.04），eGFR从43（5 - 110）降至41（5 - 88）ml/min/1.73m²，差异无统计学意义（p值 = 0.3）。8例（22.2%）、12例（34.4%）和16例（44.4%）患者的eGFR分别保持稳定、升高和降低。A组血清肌酐显著升高，eGFR降低但差异无统计学意义（p值 = 0.04和0.09），而B组血清肌酐和eGFR变化差异无统计学意义（p值 = 0.5和0.9）。在B组中，9个（21.4%）肾单位仍留置双J管。
对于特发性RPF，UOR使78.6%的肾单位避免了留置输尿管支架，长期肾功能结局明显更好。
