Lei Hanqi, Cui Yajiao, Huang Mengjun, Jiang Donggen, Li Yamei, Pang Jun
Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China.
BJUI Compass. 2025 Jul 1;6(7):e70042. doi: 10.1002/bco2.70042. eCollection 2025 Jul.
Allium stents are widely used in patients with ureteral stricture, with ongoing research continuously evaluating their clinical safety and efficacy.
This study aimed to describe our technique and report the outcomes of Allium stent in the treatment of refractory ureteral strictures.
We retrospectively collected perioperative data on all patients treated with Allium stents in our department between January 2017 and April 2024 and assessed their clinical outcomes.
Following ureteroscopy, a guidewire was advanced under fluoroscopic guidance into the renal pelvis. The retrograde ureterography was performed to determine the location and length of the ureteral stricture. Dilation was performed using a ureteral balloon dilator, a flexible ureteroscope sheath, or a rigid ureteroscope. Subsequently, the Allium stent was deployed into the stricture segment and confirmed via fluoroscopic imaging.
A total of 23 patients (25 ureters) were included, with a mean age of 57.7 years (32-76 years). The mean length of ureteral strictures was 4.5 cm (range: 1-18 cm). All stents were successfully positioned. As of December 2024, the stent patency rate was 68%, with a median follow-up of 39.5 months (13-67 months). In eight patency failure cases, the mean indwelling time was 14 months, with the shortest recorded duration being 2 months. Causes of failure included four (50%) stent migration, one (12.5%) encrustation, two (25%) persistent stenosis and severe infection (12.5%). Management strategies for these cases included two (25%) stent removal, two (25%) robot-assisted pyeloureteroplasty, one (12.5%) ureterolithotripsy, one (12.5%) exchange with a new Allium stent, one (12.5%) add new Allium stent, and one (12.5%) replacement with a different type of metal stent. Notably, one case of a ruptured ureter was successfully bridged with an Allium stent, and another case of a uretero-vaginal fistula was effectively treated with Allium stent, both without complications.
Allium stents appear to be a feasible and effective treatment for various ureteral strictures, including cases of ureteral perforation and rupture. However, long-term complications such as stent migration and occlusion remain challenges that should not be overlooked.
葱式支架广泛应用于输尿管狭窄患者，相关研究不断评估其临床安全性和有效性。
本研究旨在描述我们的技术，并报告葱式支架治疗难治性输尿管狭窄的疗效。
设计、地点和参与者：我们回顾性收集了2017年1月至2024年4月在我科接受葱式支架治疗的所有患者的围手术期数据，并评估了他们的临床结局。
输尿管镜检查后，在荧光透视引导下将导丝推进至肾盂。进行逆行输尿管造影以确定输尿管狭窄的位置和长度。使用输尿管球囊扩张器、可弯曲输尿管镜鞘或硬性输尿管镜进行扩张。随后，将葱式支架置入狭窄段，并通过荧光透视成像确认。
共纳入23例患者（25条输尿管），平均年龄57.7岁（32 - 76岁）。输尿管狭窄的平均长度为4.5厘米（范围：1 - 18厘米）。所有支架均成功定位。截至2024年12月，支架通畅率为68%，中位随访时间为39.5个月（13 - 67个月）。在8例通畅失败的病例中，平均留置时间为14个月，最短记录时长为2个月。失败原因包括4例（50%）支架移位、1例（12.5%）结壳、2例（25%）持续性狭窄和1例（12.5%）严重感染。这些病例的处理策略包括2例（25%）取出支架、2例（25%）机器人辅助肾盂输尿管成形术、1例（12.5%）输尿管碎石术、1例（12.5%）更换新的葱式支架、1例（12.5%）增加新的葱式支架以及1例（12.5%）更换为不同类型的金属支架。值得注意的是，1例输尿管破裂病例成功用葱式支架桥接，另1例输尿管阴道瘘病例用葱式支架有效治疗，均无并发症。
葱式支架似乎是治疗各种输尿管狭窄（包括输尿管穿孔和破裂病例）的一种可行且有效的方法。然而，支架移位和阻塞等长期并发症仍然是不容忽视的挑战。
