Fransen van de Putte Elisabeth E, de Wall Liesbeth L, van Werkhoven Erik, Heldeweg Eddi A, Bex Axel, van der Poel Henk G, van Rhijn Bas W G, Horenblas Simon, Hendricksen Kees
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Urol Int. 2018;100(1):18-24. doi: 10.1159/000475508. Epub 2017 Aug 18.
Uretero-ileal strictures (UES) following urinary diversion are therapeutically challenging. We compared the efficacy, safety and renal outcome following therapeutic endo-urological techniques (EUTs) and open surgical revision of the anastomosis (SRA) for UES.
We retrospectively analysed all EUTs and SRAs performed for UES in 2 hospitals between 1987 and 2015. Restenosis was defined as recurrent radiographically diagnosed hydronephrosis and re-intervention. Renal function (estimated glomerular filtration rate [eGFR]) decrease was correlated with the number of EUTs per patient.
Eighty-five UES were treated with 105 EUTs and 31 open revisions. Due to total obstruction, 28 (27%) EUTs were aborted. During a median follow-up of 33 months, restenosis occurred following 53 out of 77 (69%) completed EUTs and 4 out of 31 (13%) SRAs (p < 0.001 on univariable and multivariable analyses). No serious (Clavien ≥3b) EUT-related complications occurred vs. 5 (19%) related to SRA (p < 0.001). The number of finalised EUTs was independently associated with eGFR loss (β = 12.3 mL/min/1.73 m2 loss per EUT, p = 0.008), with a significant cutoff value of >1 EUTs. SRA did not affect renal function (β = 6.8 mL/min/1.73 m2 loss, p = 0.276).
Although EUTs are less invasive, they have an inferior efficacy to SRA. Our results suggest that a maximum of one EUT may be attempted without significantly compromising renal function.
尿流改道术后输尿管-回肠吻合口狭窄（UES）的治疗具有挑战性。我们比较了治疗性腔内泌尿外科技术（EUT）和开放性吻合口手术修复（SRA）治疗UES的疗效、安全性及肾脏转归。
我们回顾性分析了1987年至2015年间在两家医院对UES进行的所有EUT和SRA。再狭窄定义为影像学再次诊断为肾盂积水且需再次干预。肾功能（估计肾小球滤过率[eGFR]）下降与每位患者接受EUT的次数相关。
85例UES接受了105次EUT和31次开放性修复。由于完全梗阻，28次（27%）EUT未完成。在中位随访33个月期间，77次完成的EUT中有53次（69%）发生再狭窄，31次SRA中有4次（13%）发生再狭窄（单变量和多变量分析p<0.001）。未发生严重的（Clavien≥3b级）与EUT相关的并发症，而与SRA相关的有5例（19%）（p<0.001）。完成的EUT次数与eGFR降低独立相关（每次EUT导致eGFR降低12.3 mL/min/1.73 m²，p = 0.008），>1次EUT时有显著临界值。SRA不影响肾功能（eGFR降低6.8 mL/min/1.73 m²，p = 0.276）。
尽管EUT的侵入性较小，但其疗效低于SRA。我们的结果表明，在不显著损害肾功能的情况下，最多可尝试1次EUT。
