Fischer Katherine M, Louie Michael, Mucksavage Phillip
Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, USA.
Department of Urology, University of California Irvine Health, Irvine, USA.
Curr Urol Rep. 2018 Jun 11;19(8):64. doi: 10.1007/s11934-018-0818-8.
Ureteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them.
Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this. Recent research has focused on trying to modify stents including the creation of drug eluting stents as well as preventing symptoms with intravesical instillation of medications in the operative room at the time of placement. Some of these approaches show promise, but anticholinergic and alpha-blocking medications remain the only treatments for stent-related symptoms with reasonable evidence to support them. Current evidence suggests that a multimodal approach to stent-related symptoms and pain with alpha-blockers, anticholinergic medications, and anti-inflammatory and narcotic pain medications is likely the most effective. Further research is needed to better investigate many novel techniques for decreasing stent-related symptoms. This continues to be an important area of research given the need for ureteral stents in urology and the high prevalence of patient discomfort related to stent placement.
输尿管支架置入是一种非常常见的泌尿外科手术，也是包括输尿管镜检查在内的许多微创手术的必要组成部分。尽管其应用广泛，但支架置入仍会导致约80%的患者出现令人困扰的泌尿系统症状和疼痛。本综述讨论了输尿管支架相关症状的潜在机制、当前症状管理方法及其支持证据。
尽管对其进行了广泛研究，但支架相关症状的确切原因仍不清楚，可能与支架远端卷曲对膀胱的刺激、尿液通过支架反流至肾盂以及由此产生的高压传导有关。最近的研究集中在尝试改进支架，包括制造药物洗脱支架，以及在放置支架时在手术室膀胱内灌注药物以预防症状。其中一些方法显示出前景，但抗胆碱能药物和α受体阻滞剂仍然是有合理证据支持的治疗支架相关症状的唯一方法。目前的证据表明，采用α受体阻滞剂、抗胆碱能药物、抗炎和麻醉性止痛药物的多模式方法来治疗支架相关症状和疼痛可能是最有效的。需要进一步研究以更好地探究许多减少支架相关症状的新技术。鉴于泌尿外科对输尿管支架的需求以及与支架置入相关的患者不适的高发生率，这仍然是一个重要的研究领域。
