Wang Mingrui, Wang Qi, Hu Hao, Lai Jinhui, Tang Xinwei, Wan Chunyan, Xu Kexin, Xu Tao
Department of Urology, Peking University People's Hospital; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):919-922. doi: 10.19723/j.issn.1671-167X.2024.05.026.
To investigate the initial experience of coated metal ureteral stent (CMUS) for treatment of pelvic lipomatosis induced hydronephrosis (PLH). The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed. Inclusion criteria included: Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity, bladder elevation in an "inverted pear shape", and bladder wall thickening; Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis; Unilateral or bilateral hydronephrosis and ureteromegaly. Exclusion criteria included: Ureteral atresia; Recurrent obstruction of the bladder outlet. Preoperative baseline data included age, gender, serum creatinine, pelvis width and ureteric stent symptoms questionnaire (USSQ) score. Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography. Postoperative follow-up data included serum creatinine, pelvis width, and USSQ score. In the study, 8 patients (11 sides) with PLH were all male, with an average age of (38.7±8.6) years. Unilateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases. Preoperative mean serum creatinine was (90.0±10.3) μmol/L, and the mean renal pelvis width was (3.0±1.5) cm. The lower ureteral stricture was found in all cases, and the mean stricture length was (1.9±0.9) cm. Before operation, 3 patients had ureteral Double-J stents, with USSQ scores of 97.0, 68.0 and 100.0, respectively. Five patients underwent retrograde CMUS stenting, and 3 patients retrograde and antegrade. At the last follow-up, the average serum creatinine was (82.0±11.1) μmol/L and the mean renal pelvis width was (1.9±0.5) cm, which were significantly lower than those before operation (=3.12, =0.02; =3.23, =0.02). In the 3 patients with Double-J stent before surgery, the USSQ scores were 87.0, 62.0 and 89.0, respectively, which were significantly improved after CMUS stenting. The average follow-up time was (10.0±6.3) months. During the follow-up, 1 patient developed CMUS related symptoms, and no stent-associated infection and stent encrustation were found. In one case, the stent migrated to the bladder 3 months after operation, and the hydronephrosis disappeared after 3 months follow-up. CMUS stenting for treatment of PLH has certain efficacy and safety, which can explore a new therapeutic method for the long-term treatment of PLH.
探讨覆膜金属输尿管支架（CMUS）治疗盆腔脂肪增多症所致肾积水（PLH）的初步经验。回顾性分析2018年8月至2021年2月在北京大学人民医院接受CMUS治疗的8例诊断为PLH患者的临床及随访资料。纳入标准包括：盆腔内膀胱周围脂肪组织过多的影像学证据、膀胱呈“倒梨形”抬高及膀胱壁增厚；膀胱镜检查提示膀胱黏膜滤泡样增生且活检病理提示腺性膀胱炎；单侧或双侧肾积水及输尿管扩张。排除标准包括：输尿管闭锁；膀胱出口反复梗阻。术前基线数据包括年龄、性别、血清肌酐、肾盂宽度及输尿管支架症状问卷（USSQ）评分。术中数据包括逆行尿路造影观察到的输尿管狭窄部位及长度。术后随访数据包括血清肌酐、肾盂宽度及USSQ评分。本研究中，8例（11侧）PLH患者均为男性，平均年龄（38.7±8.6）岁。5例为单侧肾积水，3例为双侧肾积水。术前平均血清肌酐为（90.0±10.3）μmol/L，平均肾盂宽度为（3.0±1.5）cm。所有病例均发现输尿管下段狭窄，平均狭窄长度为（1.9±0.9）cm。术前3例患者有输尿管双J支架，USSQ评分分别为97.0、68.0和100.0。5例患者行逆行CMUS支架置入，3例患者行逆行及顺行置入。末次随访时，平均血清肌酐为（82.0±11.1）μmol/L，平均肾盂宽度为（1.9±0.5）cm，均显著低于术前（=3.12，=0.02；=3.23，=0.02）。术前有双J支架的3例患者，USSQ评分分别为87.0、62.0和89.0，CMUS支架置入后均显著改善。平均随访时间为（10.0±6.3）个月。随访期间，1例患者出现与CMUS相关的症状，未发现支架相关感染及支架结壳。1例患者术后3个月支架迁移至膀胱，随访3个月后肾积水消失。CMUS支架置入治疗PLH具有一定的疗效及安全性，可为PLH的长期治疗探索一种新的治疗方法。
