Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Int J Surg. 2021 Nov;95:106161. doi: 10.1016/j.ijsu.2021.106161. Epub 2021 Oct 30.
The management of ureteral stricture is still a challenge for urologists. The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stents (URS) in ureteral strictures.
We performed URS placement procedures for ureteral stricture from Jan 2019 to July 2020, and prospectively collect various data before and after the operation. A paired T test was used to compare continuous variables before and after surgery, binary logistic regression analysis was used to identify the independent risk predictors of surgical failure.
A total of 147 patients with 157 renal units received successful placement of URS. The mean operative time was 70.0 min. After a median follow-up time of 15 months, 73.2% (115/157) of stents were kept in situ. The most common complication was hematuria (13, 8.8%), followed by urinary tract infection (11, 7.5%) and pain (8, 5.4%). The volume of hydronephrosis (67.9 ± 34.9 VS 34.9 ± 51.1 cm, P = 0.0001), serum creatinine level (103.0 ± 54.5 VS 93.8 ± 45.1 μmol/L, P = 0.034) and blood urea nitrogen level (6.6 ± 6.7 VS 5.4 ± 2.4 mmol/L, P = 0.032) decreased significantly at last follow up when compared with baseline. Stricture of the distal ureter was an independent risk factor for stent failure (HR 1.77, 95% CI 1.15, 2.73, P = 0.009).
URS was found to be safe and effective for ureteral strictures with a limited complications and good long-term results. For those who are not suitable for surgical reconstruction, the URS is an alternative management.
输尿管狭窄的治疗仍然是泌尿科医生面临的挑战。本前瞻性研究旨在评估自膨式金属输尿管支架（URS）治疗输尿管狭窄的安全性和有效性。
我们于 2019 年 1 月至 2020 年 7 月进行了输尿管狭窄的 URS 置入术，并前瞻性地收集了手术前后的各种数据。采用配对 t 检验比较手术前后的连续变量，采用二元逻辑回归分析识别手术失败的独立风险预测因子。
共有 147 例 157 个肾脏单位的患者成功接受 URS 置入。手术平均时间为 70.0 分钟。中位随访时间为 15 个月后，157 个支架中有 73.2%（115/157）仍在位。最常见的并发症是血尿（13 例，8.8%），其次是尿路感染（11 例，7.5%）和疼痛（8 例，5.4%）。肾盂积水体积（67.9±34.9 VS 34.9±51.1cm，P=0.0001）、血清肌酐水平（103.0±54.5 VS 93.8±45.1μmol/L，P=0.034）和血尿素氮水平（6.6±6.7 VS 5.4±2.4mmol/L，P=0.032）在末次随访时与基线相比显著下降。输尿管下段狭窄是支架失败的独立危险因素（HR 1.77，95%CI 1.15，2.73，P=0.009）。
URS 治疗输尿管狭窄安全有效，并发症有限，长期效果良好。对于那些不适合手术重建的患者，URS 是一种替代治疗方法。
