Nicol D L, P'Ng K, Hardie D R, Wall D R, Hardie I R
Department of Surgery, University of Queensland, Australia.
J Urol. 1993 Nov;150(5 Pt 1):1375-9. doi: 10.1016/s0022-5347(17)35783-x.
An extravesical ureteral implantation with the routine use of an internal stent was performed in 358 transplants (351 cadaveric and 7 living related). The 1-year patient and graft survival was 93% and 87%, respectively, with a minimum followup of 2 years. Ureteral complications developed in 9 patients (2.6%), with 3 fistulas, 2 of which resolved spontaneously, and 6 stenoses following stent removal. Nephrostomy drainage and antegrade stenting were initially attempted in all cases of stenosis, and were successful in 4. Revision of the ureteral anastomosis was required in 1 case of fistula and 2 cases of stenosis (0.9%). Extrinsic compression resulted in ureteral obstruction in 3 cases (2 lymphoceles and 1 hematoma), which resolved following drainage. Stent related complications occurred in 8 patients (2.2%), including obstruction due to the stent in 2 cases, breakage during removal in 3 leaving fragments in the upper urinary tract, proximal migration of 2 stents that were retrieved via percutaneous nephrostomy and calculus formation on 1 stent in a patient with hyperparathyroidism, necessitating extracorporeal shock wave lithotripsy for stent removal. In the cases with ureteral or stent related complications 1-year patient and graft survival was 100%. These results suggest that ureteral stents used routinely in renal transplantation are associated with a low incidence of urinary leaks, early postoperative obstruction and subsequent surgery for urological complications. However, a small number of unique problems related to stent use or malfunction may occur. Minimally invasive strategies using percutaneous nephrostomy and antegrade stenting are effective in managing the majority of complications that occur following ureteral stenting in renal transplant recipients.
358例肾移植患者（351例尸体供肾和7例亲属活体供肾）采用膀胱外输尿管植入术并常规使用内支架。1年时患者和移植物存活率分别为93%和87%，最短随访时间为2年。9例患者（2.6%）出现输尿管并发症，其中3例发生瘘，2例自行愈合，6例在拔除支架后出现狭窄。所有狭窄病例最初均尝试进行肾造瘘引流和顺行支架置入，4例成功。1例瘘和2例狭窄（0.9%）需要进行输尿管吻合口修复。外在压迫导致3例输尿管梗阻（2例淋巴囊肿和1例血肿），引流后梗阻解除。8例患者（2.2%）出现与支架相关的并发症，包括2例支架梗阻、3例拔除时断裂并在上尿路残留碎片、2例支架近端移位，通过经皮肾造瘘取出，1例甲状旁腺功能亢进患者的支架上形成结石，需要进行体外冲击波碎石术以取出支架。在出现输尿管或支架相关并发症的病例中，1年时患者和移植物存活率为100%。这些结果表明，肾移植中常规使用的输尿管支架与尿漏、术后早期梗阻及随后泌尿外科并发症手术的发生率较低相关。然而，可能会出现一些与支架使用或故障相关的独特问题。采用经皮肾造瘘和顺行支架置入的微创策略对于处理肾移植受者输尿管支架置入后发生的大多数并发症有效。
