Weinberger Sarah, Hubatsch Mandy, Klatte Tobias, Neymeyer Jörg, Friedersdorff Frank
Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany.
Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, 10365 Berlin, Germany.
J Clin Med. 2023 May 6;12(9):3317. doi: 10.3390/jcm12093317.
Ureteral complications such as urinary leak, ureteral necrosis or ureteral stenosis are common complications after renal transplantation with major short- and long-term issues, including graft impairment and graft loss. At present, there is no agreement on the optimal management of ureteral complications. The aim of the current study was to evaluate the safety and efficacy of the self-expanding, large-caliber Allium ureteral stent in patients with ureteral complications following renal transplantation. In this retrospective study, the electronic database of Charité University Hospital was screened for patients receiving the self-expandable Allium ureteral stent in the transplant ureter after kidney transplantation between January 2016 and March 2022. Descriptive statistics were used to describe the outcomes. There were six men and four women with a median age of 61 years (interquartile range, 55 to 68 years). Nine out of 10 patients had ureteric stenosis, which was diagnosed at a median of two years (interquartile range 10 months to 9 years) following renal transplantation. The median operating time was 49 min (interquartile range, 30 to 60 min). Endoscopic Allium stent placement was successful in all patients with ureteric stenosis. The median length of stay in the hospital was four days (interquartile range 2 to 7 days). Only one patient (#5) had a postoperative grade IIIb Clavien-Dindo complication. Patients had follow-ups every 3 months with ultrasound and serum creatinine. Dislocation of the Allium stent was seen in four patients; all occurred within three months. Ultimately, three patients required ureteric re-implantation, two of which had early dislocation of the stent. Six patients are managed with a permanent Allium stent. The median dwell time was 11 months (interquartile range 3 to 20 months) and maximum dwell time was 23 months. The overall success rate was 60% (6 out of 10). According to our data, the Allium stent represents a safe and minimally invasive option with a success rate of 60%. It might, therefore, represent an alternative to DJ stents, nephrostomies or immediate re-implantation. As all dislocations occurred within three months, frequent early postoperative follow-up is required.
输尿管并发症，如尿漏、输尿管坏死或输尿管狭窄，是肾移植后常见的并发症，会引发严重的短期和长期问题，包括移植肾损害和移植肾丢失。目前，对于输尿管并发症的最佳处理方法尚无共识。本研究的目的是评估自膨式大口径葱状输尿管支架在肾移植术后输尿管并发症患者中的安全性和有效性。在这项回顾性研究中，对Charité大学医院的电子数据库进行筛选，找出2016年1月至2022年3月期间在肾移植后于移植输尿管中置入自膨式葱状输尿管支架的患者。采用描述性统计来描述结果。共有6名男性和4名女性，中位年龄为61岁（四分位间距为55至68岁）。10名患者中有9名患有输尿管狭窄，在肾移植后中位2年（四分位间距为10个月至9年）时被诊断出来。中位手术时间为49分钟（四分位间距为30至60分钟）。内镜下葱状支架置入在所有输尿管狭窄患者中均获成功。中位住院时间为4天（四分位间距为2至7天）。只有1例患者（病例5）出现术后Ⅲb级Clavien-Dindo并发症。患者每3个月进行超声和血清肌酐检查随访。4例患者出现葱状支架移位；均发生在3个月内。最终，3例患者需要进行输尿管再植术，其中2例支架早期移位。6例患者使用永久性葱状支架治疗。中位留置时间为11个月（四分位间距为3至20个月），最长留置时间为23个月。总体成功率为60%（10例中的6例）。根据我们的数据，葱状支架是一种安全且微创的选择，成功率为60%。因此，它可能是双J支架、肾造瘘术或立即再植术的替代方案。由于所有移位均发生在3个月内，术后需要频繁进行早期随访。
