Ter Haar Anuradha S, Parekh Rulan S, Leunissen Ralph W J, van den Joop, Lorenzo Armando J, Hebert Diane, Keijzer-Veen Mandy G, Cransberg Karlien
Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Pediatr Transplant. 2018 Feb;22(1). doi: 10.1111/petr.13065. Epub 2017 Oct 27.
Ureteral stenting after pediatric renal transplantation serves to prevent obstruction and urinary leakage, but can also cause complications. This study compares the complication rates of both methods. Data were retrospectively collected at Erasmus MC, Rotterdam, the Netherlands (splint group, n = 61) and Hospital for Sick Children, Toronto, Canada (JJ catheter group, n = 50). Outcome measures included urological interventions and incidence of UTIs during the first 3 months post-transplantation. The splint was removed after a median of 9 (IQR 8-12), the JJ catheter after 42 (IQR 36-50) days. Seven (11.5%) children in the splint group needed at least one urological re-intervention versus two in the JJ catheter group (P-value .20). UTIs developed in 19 children (31.1%) in the splint group and in twenty-five (50.0%) children in the JJ catheter group (P-value .04), with a total number of 27 vs. 57 UTIs (P-value .02). Nine (33.3%) vs. 35 (61.4%) of these, respectively, occurred during the presence of the splint (P-value <.001). Children with a JJ catheter developed more UTIs than children with a splint; the latter, however, tended to require more re-interventions. Modification of either method is needed to find the best way to stent the ureter.
小儿肾移植术后输尿管支架置入术有助于预防梗阻和尿漏，但也可能引发并发症。本研究比较了两种方法的并发症发生率。数据在荷兰鹿特丹伊拉斯姆斯医学中心（夹板组，n = 61）和加拿大多伦多病童医院（JJ导管组，n = 50）进行回顾性收集。观察指标包括移植后前3个月的泌尿外科干预措施和尿路感染发生率。夹板的中位取出时间为9天（四分位间距8 - 12天），JJ导管为42天（四分位间距36 - 50天）。夹板组有7名（11.5%）儿童至少需要进行一次泌尿外科再次干预，而JJ导管组为2名（P值为0.20）。夹板组有19名儿童（31.1%）发生尿路感染，JJ导管组有25名（50.0%）儿童发生尿路感染（P值为0.04），尿路感染总数分别为27次和57次（P值为0.02）。其中，分别有9次（33.3%）和35次（61.4%）发生在夹板留置期间（P值<0.001）。使用JJ导管的儿童比使用夹板的儿童发生更多尿路感染；然而，后者往往需要更多的再次干预。需要对这两种方法进行改进以找到输尿管支架置入的最佳方式。
