Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.
UROGIV Research Group, Universidad del Valle, Cali, Colombia.
BJU Int. 2021 Mar;127(3):292-299. doi: 10.1111/bju.15237. Epub 2020 Sep 25.
To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction.
We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries).
We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I = 0%).
We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.
确定恶性输尿管梗阻患者内镜下输尿管支架置入失败的相关因素。
我们在 Medline（医学文献分析和检索系统在线版）、Excerpta Medica dataBASE（EMBASE）、Literatura Latino-Americana e do Caribe em Ciências da Saúde 数据库（LILACS）和 Cochrane 对照试验中心注册库（CENTRAL）中进行了检索策略。我们纳入了接受 JJ 导管插入术的恶性输尿管梗阻患者。这些研究报告了失败率和危险因素，例如膀胱侵犯或三角区变形、肾积水、肾功能衰竭、先前的放疗、年龄、梗阻病因和患者的健康状况。我们使用 R 软件（“meta”和“metafor”库）进行了 meta 分析。
我们纳入了 9 项符合纳入标准的研究，共 761 名患者，平均年龄为 60.5 岁。这些研究评估了第 1 个 30 天内的失败时间。报告的失败率为 32%（95%置信区间 [CI] 21-45%；I = 88%）。关于失败的危险因素，膀胱侵犯或三角区变形的危险比（HR）为 4.8（95% CI 1.28-8.5；I = 97.4%）；严重肾积水的 HR 为 3.92（95% CI 0.32-7.52；I = 93.9%）；年龄 <65 岁的 HR 为 0.93（95% CI 0.8-0.9；I = 0%）。
我们发现恶性输尿管梗阻患者内镜下尿路减压术失败的可能性较高。膀胱侵犯或三角区变形和年龄 >65 岁等因素增加了失败的风险。
