45例接受逆行输尿管镜检查以处理上尿路异常的新膀胱患者的经验。

Experience with 45 Consecutive Patients with Neobladders Undergoing Retrograde Ureteroscopy for Upper Tract Abnormalities.

作者信息

Singla Nirmish, Montie James E, Lee Cheryl T, Wolf J Stuart, Faerber Gary J

机构信息

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas (NS), and Department of Urology, University of Michigan, Ann Arbor, Michigan (JEM, CTL, JSW, GJF).

出版信息

Urol Pract. 2015 Sep;2(5):244-249. doi: 10.1016/j.urpr.2014.12.005.

DOI:10.1016/j.urpr.2014.12.005

PMID:31930163

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6953908/

Abstract

INTRODUCTION

In this study we reviewed the feasibility, technique, complications and outcomes of retrograde ureteroscopy in patients with orthotopic neobladders.

METHODS

We retrospectively reviewed our retrograde ureteroscopic experience in patients with orthotopic ileal neobladder diversions. Data were collected and analyzed regarding patient characteristics, indications, technique, success and complications of the procedure.

RESULTS

Between 1995 and 2013, 45 patients with neobladders underwent 77 retrograde ureteroscopy sessions on 97 renal units for filling defects (47 cases), urothelial thickening (9), calculi (4), positive cytology (27) and/or positive fluorescence in situ hybridization (15) on followup. The ureter and renal pelvis were successfully instrumented in 78 of 97 units (80.4%), with 85.3% success in Hautmann-type neobladders (75 renal units attempted), 50% in Studer-type neobladders (8 renal units attempted) and 71.4% in unascertained-type neobladders (14 renal units attempted). Causes of failure involved the inability to locate the ureteral orifice (8 cases), to cannulate the orifice (6 cases) or to advance the ureteroscope due to tortuosity (5 cases). Among the successful attempts with appropriately documented findings 35.9% of cases with filling defects (39) were confirmed malignant and 61.5% were confirmed benign by ureteroscopy. All cases with a positive cytology (23) and 85.7% of cases with positive fluorescence in situ hybridization (14) were confirmed malignant by retrograde ureteroscopy, and 2 of the 4 cases of calculi were successfully managed retrogradely.

CONCLUSIONS

Retrograde ureteroscopic evaluation of upper tract abnormalities is feasible and practical in patients with orthotopic neobladders. Identification and cannulation of the ureteral orifice are challenging, particularly in tortuous situations, but difficulties can be overcome with fluoroscopic techniques. Retrograde ureteroscopy avoids the morbidity of percutaneous access with minimal complications.

摘要

引言

在本研究中，我们回顾了原位新膀胱患者逆行输尿管镜检查的可行性、技术、并发症及结果。

方法

我们回顾性分析了原位回肠新膀胱患者的逆行输尿管镜检查经验。收集并分析了患者特征、适应证、技术、手术成功率及并发症等数据。

结果

1995年至2013年期间，45例新膀胱患者的97个肾单位接受了77次逆行输尿管镜检查，检查原因包括随访时发现充盈缺损（47例）、尿路上皮增厚（9例）、结石（4例）、细胞学阳性（27例）和/或荧光原位杂交阳性（15例）。97个肾单位中的78个（80.4%）成功完成输尿管和肾盂操作，其中Hautmann型新膀胱（尝试75个肾单位）成功率为85.3%，Studer型新膀胱（尝试8个肾单位）成功率为50%，未明确类型新膀胱（尝试l4个肾单位）成功率为71.4%。失败原因包括无法找到输尿管口（8例）、无法插入输尿管口（6例）或因输尿管迂曲无法推进输尿管镜（5例）。在有适当记录结果的成功尝试中，输尿管镜检查确诊35.9%的充盈缺损病例（39例）为恶性，61.5%为良性。所有细胞学阳性病例（23例）和85.7%的荧光原位杂交阳性病例（14例）经逆行输尿管镜检查确诊为恶性，4例结石病例中的2例经逆行操作成功处理。