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在高容量转诊中心中输尿管 Memokath 支架的命运:独立的长期结果回顾。

The Fate of Ureteral Memokath Stent(s) in a High-Volume Referral Center: An Independent Long-Term Outcomes Review.

机构信息

Department of Urology, Royal London Hospital, Bart's Health NHS Trust, London, United Kingdom.

Bart's and the London School of Medicine and Dentistry, London, United Kingdom.

出版信息

J Endourol. 2021 Feb;35(2):180-186. doi: 10.1089/end.2020.0542. Epub 2020 Sep 23.

DOI:10.1089/end.2020.0542
PMID:32762263
Abstract

To independently assess upper urinary tract Memokath (MMK-051) stent outcomes in a national tertiary referral center. Two researchers, completely independent to the treating team, reviewed electronic MMK-051 stent(s) patient management records. Outcomes included time to first complication, complication(s)-severity, MMK-051 stent lifespan and change incidence, salvage therapy, further surgical intervention, and mortality. One hundred patients received 162 MMK-051 stent(s) (59% with malignant and 63% with distal ureteral obstruction [UO]) with only three lost to follow-up (FU). At 5-year mean FU, only 25 patients had complication-free original MMK-051 stents (14 alive, 11 dead). Of the remaining 75 patients, 22 had other stents, 12 had major surgery (e.g., nephrectomy), 3 became dialysis dependent, and 14 stabilized without ureteral stenting after original MMK-051 removal. Malignant obstruction patients had greater original MMK-051 stent longevity ( < 0.02), but also 20 of the 21 deaths (95%). The 72% mean 5-year stent complication rate included migration (46%), blockage (34%), nonfunctioning kidney (8%), urosepsis needing intravenous antibiotics (8%), and others (6%), including one postoperative death, one ureteral injury, and two with intractable pain. Median time to first complication was 12.5 months. MMK-051 stents had optimal utility in managing malignant UO and in those unfit for corrective surgery. Longer independently assessed mean 5-year outcomes review revealed much higher complication rates (72%) than previously reported. Future international metallic ureteral stent guidelines should encourage clinicians to adopt patient-centered multidisciplinary assessment and selection, with counseling plus goal-setting, and harmonized long-term protocol-based reporting, for optimized future patient safety and outcomes.

摘要

目的

在一家国家三级转诊中心独立评估上尿路 Memokath(MMK-051)支架的结果。两位研究人员,完全独立于治疗团队,回顾了电子 MMK-051 支架患者管理记录。结果包括首次并发症的时间、并发症严重程度、MMK-051 支架的寿命和变化发生率、挽救治疗、进一步的手术干预和死亡率。100 名患者接受了 162 个 MMK-051 支架(59%为恶性,63%为远端输尿管梗阻[UO]),只有 3 例失访(FU)。在 5 年平均 FU 时,只有 25 名患者的原始 MMK-051 支架无并发症(14 例存活,11 例死亡)。在其余 75 名患者中,22 名患者有其他支架,12 名患者接受了主要手术(如肾切除术),3 名患者需要透析,14 名患者在移除原始 MMK-051 后无需输尿管支架即可稳定。恶性梗阻患者的原始 MMK-051 支架寿命更长( < 0.02),但 21 例死亡中有 20 例(95%)。72%的平均 5 年支架并发症发生率包括迁移(46%)、阻塞(34%)、无功能肾(8%)、需要静脉抗生素的尿脓毒症(8%)和其他(6%),包括 1 例术后死亡、1 例输尿管损伤和 2 例难治性疼痛。首次并发症的中位时间为 12.5 个月。MMK-051 支架在治疗恶性 UO 和不适合矫正手术的患者方面具有最佳的应用价值。更长时间的独立评估平均 5 年结果显示,并发症发生率(72%)高于之前报道。未来的国际金属输尿管支架指南应鼓励临床医生采用以患者为中心的多学科评估和选择,同时进行咨询、目标设定,并采用基于长期协议的协调报告,以优化未来患者的安全和结果。

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