Vogt Benoît, Chokri Ilham
Department of Urology, Polyclinique De Blois, 1 Rue Robert Debré, 41260 La Chaussée Saint-Victor, France.
Laboratory of Anatomocytopathology, 1 Av Prof Alexandre Minkowski, 37170 Chambray-Lès-Tours, France.
Adv Urol. 2020 Jul 2;2020:1204897. doi: 10.1155/2020/1204897. eCollection 2020.
Ureteral stent intolerance reduces patients' quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread.
After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer.
A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 (=0.001).
Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.
输尿管支架不耐受会降低患者的生活质量。有人提出，改变支架形状可能会减轻不适。在先前的研究中，带有细0.3F缝线的创新性猪尾缝合支架（即JFil®或MiniJFil®）显著减少了与支架相关的症状。偶然发现，含有缝线的输尿管出现了扩张。此外，在内镜检查中，缝线周围的输尿管壁未见炎症。在这项初步研究中，我们评估了健康人输尿管或置入双猪尾支架或缝线时的输尿管炎症。
在患者同意并纳入方案后，在膀胱肿瘤膀胱切除术过程中收集了15段输尿管。用苏木精-伊红染色的组织切片评估输尿管炎症。对输尿管切片进行组织学分级（累积范围为0至6），以评估黏膜炎症和肌层炎症。
在所有置入双猪尾支架的输尿管病例中均观察到明显的输尿管炎症反应，平均炎症评分为4.8±0.4。置入细缝线的输尿管仅1例出现炎症，平均炎症评分为1.8±1.3（P=0.001）。
尽管该研究受患者数量较少的限制，但证实了双猪尾支架在所有病例中均会引发输尿管炎症，且0.3F细缝线引起的输尿管炎症比双猪尾支架少。为了减少黏膜刺激，减少尿路内材料的概念似乎很有必要。JFil®或MiniJFil®缝线可以满足这一要求。
