Bozaci Ali Cansu, Altan Mesut, Haberal Hakan Bahadir, Söğütdelen Emrullah, Aki Fazil Tuncay, Erkan İlhan
Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
Int J Urol. 2021 May;28(5):520-525. doi: 10.1111/iju.14496. Epub 2021 Jan 21.
To report our experience with ureterolysis for the management of retroperitoneal fibrosis.
The data of 25 patients who underwent ureterolysis due to primary retroperitoneal fibrosis between 2002 and 2017 were reviewed retrospectively. Initial symptoms, laterality, renal function status (initial/final), operation complications and serum creatinine levels (diagnosis/preoperative/6 months, 12 months postoperatively) were recorded. After surgery, patients were followed up by ultrasonography and serum creatinine levels. Patients with impaired results underwent furosemide renogram and/or late phase of computed tomography. Factors affecting final serum creatinine levels were evaluated. The χ -test was used for nominal data among groups. The level of statistical significance was set as P < 0.05.
A total of 19 patients (76%) were operated bilaterally. The mean follow-up period was 46.2 ± 9.2 months. Among 44 operated renal units, non-functioning kidney developed in seven (15.9%). A total of 34 renal units (77.3%) did not require any additional surgical intervention, and two underwent balloon dilatation (4.5%), one (2.25%) followed with double J stent changes. Two patients developed end-stage renal disease secondary to bilateral unresolved obstruction. High final serum creatinine levels developed in eight (32%) patients without dialysis. Eight patients (32%) were treated with immunosuppressive therapy for systemic recurrence. There was a significant relationship between preoperative serum creatinine levels with final serum creatinine levels (P = 0.005). There was no statistically significant relationship between diagnosis serum creatinine levels with final serum creatinine levels and postoperative dialysis requirement (P = 0.79 and P = 0.817, respectively).
Ureterolysis provides acceptable success with low complication rates in patients with retroperitoneal fibrosis. Preoperative high-serum creatinine levels can be considered as a risk factor for long-term renal impairment and these patients should be followed closely.
报告我们在输尿管松解术治疗腹膜后纤维化方面的经验。
回顾性分析2002年至2017年间因原发性腹膜后纤维化接受输尿管松解术的25例患者的数据。记录初始症状、病变侧别、肾功能状态（初始/最终）、手术并发症及血清肌酐水平（诊断时/术前/术后6个月、12个月）。术后，通过超声检查和血清肌酐水平对患者进行随访。结果不佳的患者接受速尿肾图检查和/或计算机断层扫描晚期检查。评估影响最终血清肌酐水平的因素。组间名义数据采用χ检验。统计学显著性水平设定为P<0.05。
共有19例患者（76%）接受了双侧手术。平均随访期为46.2±9.2个月。在44个接受手术的肾单位中，7个（15.9%）出现无功能肾。共有34个肾单位（77.3%）无需任何额外的手术干预，2个接受了球囊扩张（4.5%），1个（2.25%）更换了双J支架。2例患者因双侧梗阻未解除继发终末期肾病。8例（32%）未透析患者出现高最终血清肌酐水平。8例（32%）患者因全身复发接受免疫抑制治疗。术前血清肌酐水平与最终血清肌酐水平之间存在显著相关性（P=0.005）。诊断时血清肌酐水平与最终血清肌酐水平及术后透析需求之间无统计学显著相关性（分别为P=0.79和P=0.817）。
输尿管松解术在腹膜后纤维化患者中成功率可接受，并发症发生率低。术前高血清肌酐水平可被视为长期肾功能损害的危险因素，应对这些患者进行密切随访。
