Maybody Majid, Shay Wesley K, Fleischer Deborah A, Hsu Meier, Moskowitz Chaya
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
World J Clin Urol. 2020 Sep 12;9(1):1-8. doi: 10.5410/wjcu.v9.i1.1.
Ureteral stent and nephroureterostomy tube (NUT) are treatments of ureteral obstruction. Ureteral stent provides better quality of life. Internalization of NUT is desired whenever possible.
To assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder NUT.
Our Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 ( = 578). Cases were excluded due to lack of imaging of bladder ( = 37), incomplete aspiration of bladder ( = 324), no attempt at capping NUT ( = 166), and patients with confounding factors interfering with results of capping trial including non-compliant bladder, bladder outlet obstruction and catheter malposition ( = 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) most with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn's disease. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated.
Among patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 0.65-0.92) catheters were successfully capped (range 12-94 d, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Seven capping trials (19%, 95%CI: 0.08-0.35) were unsuccessful (range 2-22 d, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/vomiting (1).
Capping trial success among patients with complete aspiration of retained contrast/ urine from bladder NUT appears high.
输尿管支架和肾输尿管造口管（NUT）是治疗输尿管梗阻的方法。输尿管支架能提供更好的生活质量。只要有可能，就希望将NUT内置化。
评估膀胱NUT内残留造影剂完全吸出的癌症患者封堵试验的结果。
我们的机构审查委员会批准了对2013年6月至2015年6月期间进行的所有NUT置入、NUT更换以及肾造瘘导管转换为NUT的病例（n = 578）进行回顾性研究。因膀胱成像缺失（n = 37）、膀胱抽吸不完全（n = 324）、未尝试封堵NUT（n = 166）以及存在干扰封堵试验结果的混杂因素（包括膀胱顺应性差、膀胱出口梗阻和导管位置不当）的患者（n = 14）被排除。研究组包括34例患者的37例手术（男性19例，女性15例，年龄2 - 83岁，平均58岁，中位数61岁），大多数患有癌症（前列腺癌8例、子宫内膜癌5例、膀胱癌4例、结直肠癌4例、乳腺癌2例、胃癌2例、神经母细胞瘤2例、宫颈癌1例、卵巢癌1例、肾癌1例、肉瘤1例、尿路上皮癌1例和睾丸癌1例），1例患有克罗恩病。审查病历以评估封堵试验的结果。计算精确的95%置信区间（95%CI）。
在残留造影剂完全吸出的患者中，30根导管（81%，95%CI：0.65 - 0.92）成功封堵（时间范围12 - 94天，平均40天，中位数24.5天），直至计划转换为内置支架（23例）、常规更换（5例）、拔除（1例）或与导管无关的死亡（1例）。7次封堵试验（19%，95%CI：0.08 - 0.35）未成功（时间范围2 - 22天，平均12天，中位数10天），原因是渗漏（3例）、肌酐升高（2例）、发热/血尿（1例）和恶心/呕吐（1例）。
膀胱NUT内残留造影剂/尿液完全吸出的患者封堵试验成功率似乎较高。
