O'Brien Tim, Fernando Archie
Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.
BJU Int. 2017 Oct;120(4):556-561. doi: 10.1111/bju.13915. Epub 2017 Jun 18.
To determine the outcomes of open ureterolysis in a contemporary cohort of patients presenting with ureteric obstruction secondary to retroperitoneal fibrosis (RPF).
We conducted a prospective analysis of 50 patients undergoing open ureterolysis and omental wrap between January 2012 and January 2016 in a single centre, managed by a multi-disciplinary RPF team. Patients had a minimum follow-up of 1 year. Indications were: nephrostomy-dependent drainage (n = 5); stent failure as evidenced by persistent hydronephrosis (n = 20); severe stent symptoms (n = 22); and patient choice/pre-emptive (n = 3). Outcome measures were stent-free rate; change in renal function post-ureterolysis; operating variables (operating time, blood loss, complications, length of hospital stay); and need for further intervention.
Of the 50 patients, 48 (96%) were stent-free at 3 months and 47/50 (94%) were stent-free at 12 months. The median (interquartile range [IQR]) changes in glomerular filtration rate, according to these indication groups, at 1 year were: overall +6 (-4 to +22)% (P < 0.05); stent failure +25 (+5 to +27)% (P < 0.001); stent symptoms +0 (-17 to +6)% (P = 0.834); nephrostomy-dependent drainage -10 (-19 to -2)% (P = 0.731); and pre-emptive 0 (0 to +8)% (P = 0.5). A total of 11/50 patients (22%) underwent additional procedures: nephrectomy, n = 7; uretero-ureterostomy, n = 1; aneurysm repair, n = 1; 1 Boari flap, n = 1; and ureteric re-implant, n = 1. Serious complications (Clavien III or IV) occurred in 12% of patients. The median (IQR) blood loss was 390 (20-1,200) mL and the median (IQR) length of hospital stay was 8 (3-21) days.
This study suggests that for patients with ureteric obstruction caused by RPF, contemporary ureterolysis performed by a high-volume specialist team can successfully render patients stent- or nephrostomy-free without compromising renal function. The results suggest that ureterolysis should be considered in all patients who present with ureteric obstruction caused by RPF that does not respond quickly to standard treatment.
确定在当代一组因腹膜后纤维化（RPF）导致输尿管梗阻的患者中，开放性输尿管松解术的治疗效果。
我们对2012年1月至2016年1月期间在单一中心由多学科RPF团队管理的50例行开放性输尿管松解术和网膜包裹术的患者进行了前瞻性分析。患者的最短随访时间为1年。适应证包括：依赖肾造瘘引流（n = 5）；持续性肾积水证明支架置入失败（n = 20）；严重的支架相关症状（n = 22）；以及患者自主选择/预防性手术（n = 3）。观察指标包括无支架率；输尿管松解术后肾功能的变化；手术相关变量（手术时间、失血量、并发症、住院时间）；以及进一步干预的需求。
50例患者中，48例（96%）在3个月时无支架，47/50例（94%）在12个月时无支架。根据这些适应证分组，1年时肾小球滤过率的中位数（四分位间距[IQR]）变化为：总体+6（-4至+22）%（P < 0.05）；支架置入失败组+25（+5至+27）%（P < 0.001）；支架相关症状组+0（-17至+6）%（P = 0.834）；依赖肾造瘘引流组-10（-19至-2）%（P = 0.731）；预防性手术组0（0至+8）%（P = 0.5）。共有11/50例患者（22%）接受了额外的手术：肾切除术，n = 7；输尿管输尿管吻合术，n = 1；动脉瘤修复术，n = 1；1例Boari瓣手术，n = 1；输尿管再植术，n = 1。12%的患者发生了严重并发症（Clavien III或IV级）。失血量的中位数（IQR）为390（20 - 1200）mL，住院时间的中位数（IQR）为8（3 - 21）天。
本研究表明，对于由RPF引起输尿管梗阻的患者，由经验丰富的专科团队进行当代开放性输尿管松解术可成功使患者无需支架或肾造瘘，且不影响肾功能。结果表明，对于所有因RPF导致输尿管梗阻且对标准治疗反应不迅速的患者，均应考虑输尿管松解术。
