Hamamoto Shuzo, Taguchi Kazumi, Kawase Kengo, Unno Rei, Isogai Masahiko, Torii Koei, Iwatsuki Shoichiro, Etani Toshiki, Naiki Taku, Okada Atsushi, Yasui Takahiro
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan.
J Clin Med. 2023 Dec 16;12(24):7726. doi: 10.3390/jcm12247726.
Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US.
we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023.
A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively.
The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.
输尿管镜碎石术(URSL)后输尿管狭窄(US)已成为激光技术广泛应用后的一种严重并发症。此外,处理复杂的US具有挑战性。因此,本研究评估了机器人辅助输尿管输尿管吻合术(RAUU)在解决URSL后US方面的疗效,并分析了切断的输尿管组织的病理情况,以确定US的危险因素。
我们对2021年4月至2023年5月因URSL导致的US而接受RAUU的患者进行了一项前瞻性队列研究。
本研究共纳入14例患者,平均年龄49.8岁。影像学检查显示平均狭窄长度为22.66±7.38mm。9例(64.2%)患者既往干预失败。平均随访12.8个月时,临床和影像学上的总体成功率为92.9%,无重大并发症。病理结果显示,分别有57.1%和28.6%的患者出现微钙化和输尿管黏膜缺失。
尽管输尿管存在严重的病理改变,但对于适当选择的患者,RAUU技术有望成为URSL后US的一种可行选择。因此,微钙化向输尿管穿孔部位的迁移可能是导致US发生的一个重要因素。