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输尿管支架结壳:流行病学、病理生理学、管理及当前技术

Ureteral Stent Encrustation: Epidemiology, Pathophysiology, Management and Current Technology.

作者信息

Tomer Nir, Garden Evan, Small Alexander, Palese Michael

机构信息

Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York.

出版信息

J Urol. 2021 Jan;205(1):68-77. doi: 10.1097/JU.0000000000001343. Epub 2020 Aug 28.

Abstract

PURPOSE

Encrustation is a common phenomenon that can occur following placement of a ureteral stent into the urinary tract, and it can lead to serious complications. The following review addresses the mechanism of encrustation, the management of these stents and the newest technology developed to mitigate this issue.

MATERIALS AND METHODS

We performed a comprehensive literature search on stent encrustation including peer-reviewed publications, public product listings, and material on current and future stent technology.

RESULTS

The mechanism of encrustation is complex and multifaceted, including dwell time, patient specific risk factors, conditioning film formation, biofilm formation and mineral deposition. Several technological developments in stent materials and coatings may have a role in reducing the risk of stent encrustation. It is important to identify the extent of stent encrustation and plan treatment strategies accordingly. We propose a novel treatment algorithm for the management encrusted ureteral stents.

CONCLUSIONS

The ubiquity of ureteral stents in urology practice mandates updated knowledge about the prevention of stent encrustation, identification of high risk patients and preparedness for removal using multimodal techniques.

摘要

目的

结壳是输尿管支架置入尿路后可能出现的常见现象,可导致严重并发症。以下综述探讨了结壳的机制、这些支架的管理以及为缓解该问题而开发的最新技术。

材料与方法

我们对支架结壳进行了全面的文献检索,包括同行评审的出版物、公共产品清单以及当前和未来支架技术的资料。

结果

结壳机制复杂且多方面,包括留置时间、患者特定风险因素、调理膜形成、生物膜形成和矿物质沉积。支架材料和涂层的多项技术发展可能在降低支架结壳风险方面发挥作用。识别支架结壳的程度并据此制定治疗策略很重要。我们提出了一种用于处理结壳输尿管支架的新型治疗算法。

结论

输尿管支架在泌尿外科实践中的广泛应用要求更新关于预防支架结壳、识别高危患者以及使用多模式技术进行取出准备的知识。

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