Ohtaka Mari, Kawahara Takashi, Hayashi Yutaro, Kobayashi Ryosuke, Tsutsumi Sohgo, Ousaka Kimito, Takizawa Akitoshi, Kishida Takeshi, Yao Masahiro, Uemura Hiroji
Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan.
Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan.
BJUI Compass. 2020 Oct 15;2(1):58-63. doi: 10.1002/bco2.51. eCollection 2021 Jan.
Malignant ureteral obstruction (MUO) is often caused by advanced intra-abdominal cancers. Effective management must be attempted, but the treatment policy is unclear. Metallic ureteral stents are one of the latest options in managing MUO. Metallic ureteral stents are superior to traditional polyurethane stents. The present study retrospectively reviewed our four institutions' experiences with treating MUO using metallic ureteral stent.
A total of 45 patients who required metallic ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, JAPAN) between January 2014 and May 2016 were analyzed. We defined stent failure as having to change the ureteral stent before the scheduled ureteral stent exchange time or having to perform percutaneous nephrostomy (PCN). Complications were defined as an unscheduled hospital visit or hospitalization caused by incompatibility, infection, and pain of the metallic ureteral stent, etc., unrelated to the primary disease. We compared stent failure and the overall survival (OS) between metallic and polymeric ureteral stents. To evaluate the workload of the medical staff, we used the NASA Task Load Index (NASA-TLX) in a total of 11 urologists.
During the observation period, 8 (17.8%) patients in the metallic ureteral stent group and 10 (27.8%) in the control group developed stent failure. Complications were noted in 14 (31.1%) patients in the metallic ureteral stent group and 15 (41.7%) patients in the control group. A Kaplan-Meier analysis and log-rank test showed no significant differences between two groups in the overall survival ( = 0.673). One or more complications developed in 19 (32.2%) patients in the metallic ureteral stent group and 18 (38.3%) patients in the control group ( = 0.409). Renal dysfunction after the replacement of the ureteral stent developed in 9 (15.3%) patients in the metallic ureteral stent group and 14 (29.8%) patients in the control group. No patients developed a urinary tract infection (UTI) that required hospitalization in the metallic ureteral stent group, whereas 3 (6.4%) patients in the control group had a UTI that was treated with hospitalization. The average workload score in the six subscales was analyzed, and the scores for mental demand and performance were higher in the metallic ureteral stent group, although there was no significant difference between the metallic and polymeric ureteral stent groups.
Metallic ureteral stents showed favorable ureteral stent patency and reduced the workload for urologists.
恶性输尿管梗阻（MUO）常由晚期腹腔内癌症引起。必须尝试进行有效的治疗，但治疗策略尚不清楚。金属输尿管支架是治疗MUO的最新选择之一。金属输尿管支架优于传统的聚氨酯支架。本研究回顾性分析了我们四个机构使用金属输尿管支架治疗MUO的经验。
分析了2014年1月至2016年5月在横滨市立大学医学中心（日本横滨）因MUO需要放置金属输尿管支架的45例患者。我们将支架失败定义为必须在预定的输尿管支架更换时间之前更换输尿管支架或必须进行经皮肾造瘘术（PCN）。并发症定义为由金属输尿管支架的不相容性、感染和疼痛等引起的计划外门诊或住院，与原发性疾病无关。我们比较了金属输尿管支架和聚合物输尿管支架的支架失败率和总生存率（OS）。为了评估医务人员的工作量，我们对总共11名泌尿科医生使用了美国国家航空航天局任务负荷指数（NASA-TLX）。
在观察期内，金属输尿管支架组有8例（17.8%）患者出现支架失败，对照组有10例（27.8%）。金属输尿管支架组有14例（31.1%）患者出现并发症，对照组有15例（41.7%）。Kaplan-Meier分析和对数秩检验显示两组在总生存率方面无显著差异（=0.673）。金属输尿管支架组有19例（32.2%）患者出现一种或多种并发症，对照组有18例（38.3%）（=0.409）。金属输尿管支架组有9例（15.3%）患者在更换输尿管支架后出现肾功能不全，对照组有14例（29.8%）。金属输尿管支架组没有患者发生需要住院治疗的尿路感染（UTI），而对照组有3例（6.4%）患者因UTI住院治疗。分析了六个子量表的平均工作量得分，金属输尿管支架组的心理需求和表现得分较高，尽管金属输尿管支架组和聚合物输尿管支架组之间没有显著差异。
金属输尿管支架显示出良好的输尿管支架通畅性，并减少了泌尿科医生的工作量。
