Department of Urology, Sapporo Medical University, Sapporo, Hokkaido, Japan.
Int J Urol. 2022 Sep;29(9):1046-1053. doi: 10.1111/iju.14970. Epub 2022 Jun 30.
To clarify the incidence of postoperative hydronephrosis and verify the validity of diagnostic and therapeutic approaches for hydronephrosis after cystectomy and urinary diversion for bladder cancer.
Totally, 290 patients receiving urinary diversion from 2005 through 2017 with complete data were enrolled, including 258 (89.0%) with an ileal conduit and 32 (11.0%) with an ileal neobladder. Postoperative radiographic images were reviewed. In patients with postoperative hydronephrosis, antegrade pyelography and ureteroscopy were performed to exclude malignant etiology. Balloon dilation and open surgical revision were performed according to the conditions.
Forty-six patients (58 renal units) developed postoperative hydronephrosis. The cumulative incidence was 11.4% by a median follow-up of 59.5 months. Ureteral recurrence was detected by antegrade examinations in two patients, whereas malignant strictures were subsequently revealed in three patients. Thus, malignant etiology was found in hydronephrosis in five renal units (12.8%) of five patients (16.1%). The median times to diagnosis of hydronephrosis were 0 (interquartile range [IQR] 0-4) and 14 months (IQR 9-12) for benign and malignant strictures, respectively (p = 0.003). Of them, 31 patients (39 renal units) received interventions. Balloon dilation was performed in 13 renal units with benign strictures, and was successful in two (15.4%). Open surgical revision was performed in eight patients (11 renal units), including two with failed balloon dilation, all of which was successful.
Postoperative hydronephrosis is potentially associated with recurrent disease. Accurate differential diagnosis is challenging although antegrade procedures may be helpful in some cases. Open surgical revision is highly effective to treat benign strictures.
阐明膀胱癌术后并发肾盂积水的发生率，并验证针对膀胱癌行膀胱根治性切除和尿流改道术患者术后并发肾盂积水的诊断和治疗方法的有效性。
共纳入 2005 年至 2017 年间行尿流改道术且资料完整的 290 例患者，其中 258 例行回肠代膀胱术（89.0%），32 例行回肠新膀胱术（11.0%）。回顾术后影像学检查资料。对于术后并发肾盂积水的患者，行顺行肾盂造影和输尿管镜检查以排除恶性病因。根据具体情况，采用球囊扩张或开放手术修复。
46 例（58 个肾脏）患者术后并发肾盂积水，中位随访时间 59.5 个月时，累积发生率为 11.4%。2 例患者经顺行检查发现输尿管复发，随后 3 例患者发现恶性狭窄。因此，5 例患者（16.1%）的 5 个肾脏（12.8%）的肾盂积水被诊断为恶性病因。良性和恶性狭窄的肾盂积水诊断中位时间分别为 0（四分位距 [IQR] 0-4）和 14 个月（IQR 9-12）（p=0.003）。其中 31 例（39 个肾脏）患者接受了治疗。13 个良性狭窄肾脏行球囊扩张，2 例成功（15.4%）。8 例患者（11 个肾脏）行开放手术修复，其中 2 例球囊扩张失败患者均成功。
术后肾盂积水可能与疾病复发有关。尽管顺行检查可能对某些病例有帮助，但准确的鉴别诊断具有挑战性。开放手术修复对治疗良性狭窄非常有效。
