Initial experiences of Allium ureteral stent placement at semisupine-lithotomy position for ureteral stricture

doi:10.3877/cma.j.issn.1674-3253.2024.04.007

Abstract

Abstract:

Objective

To explore the surgical techniques and experiences of Allium ureteral stents (URS) in treating ureteral stricture with semisupine-lithotomy position.

Methods

The clinical data of 56 patients treated at Sun Yat-sen Memorial Hospital, Sun Yat-sen University were analyzed retrospectively. 15 patients had bilateral stenosis, 41 had unilateral stenosis. All patients were placed with the Allium URS in the semisupine-lithotomy position (45° semi-lumbar combined lithotomy position), retrograde rigid ureteroscope and flexible ureteroscope were inserted simultaneously, looking for location of strictures. Allium URS were inserted retrogradely with transureteroscope when the two ureteroscopes were connected. In 20 patients, multiple ureteral stents were placed in series on the stenotic side, and 94 Allium URS were successfully placed. Preoperative and postoperative serum creatinine, renal pelvis separation and postoperative complications were analyzed, and the feasibility, safety, and efficacy were assessed.

Results

After the operation, the average follow-up time was (11±6) months. Renal pelvis separation was (18±7) mm. The preoperative mean renal pelvis separation was (29±9) mm, preoperative creatinine level was 117(54-966) μmol/L, and the last follow-up creatinine level was 103(56-317) μmol/L, the last follow-up renal pelvis separation was (18±7) mm, which were significantly improved (P<0.001). Postoperative follow-up result revealed six cases with urinary irritation symptoms such as hematuria and urinary frequency within one week, and eight cases with back pain, all of them were relieved after symptomatic treatment. One case had stent migration to the bladder after 8 months and underwent Allium URS replacement and bilateral double-J stent placement, by the end of the follow-up period, the patient's hydronephrosis had significantly improved compared to before.

Conclusion

The use of Allium membrane ureteral stents at semisupine-lithotomy position for the treatment of ureteral strictures resulted in few postoperative complications, high patency rates, and was safe and effective.

Key words: Ureteral stricture, Allium ureteral stent, Semisupine-lithotomy position

Wengang Yang, Yiming Lai, Hao Huang, Hai Huang. Initial experiences of Allium ureteral stent placement at semisupine-lithotomy position for ureteral stricture[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(04): 340-345.

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Figures/Tables 5

References 25

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变量	结果
年龄[岁，(±s)]	（50±13）
性别[例(%)]
男	21（37.5）
女	35（62.5）
狭窄的病因[例(%)]
碎石术后	22（39.3）
妇科肿瘤	23（41.1）
直肠癌	1（1.8）
输尿管低级别尿路上皮癌	1（1.8）
前列腺癌	1（1.8）
肾移植术后	4（7.1）
先天性孤立肾	1（1.8）
其他	3（5.4）
狭窄侧[例(%)]
单侧	41（73.2）
双侧	15（26.8）
狭窄长度[cm，M(Q_min～Q_max)]	5.1（0.5～25.0）
尿液白细胞[个/μl，M(Q_min～Q_max)]	62（0～20 964）
尿液亚硝酸盐[例(%)]
（-）	5（8.9）
（+）	51（91.9）
术前血肌酐[μmol/L，M(Q_min～Q_max)]	117（54～966）
术前肾盂分离[mm，(±s)]	（29±9）
术前长期留置双J管时间[月，M(Q_min～Q_max)]	12（0～72）

变量	结果
年龄[岁，(±s)]	（50±13）
性别[例(%)]
男	21（37.5）
女	35（62.5）
狭窄的病因[例(%)]
碎石术后	22（39.3）
妇科肿瘤	23（41.1）
直肠癌	1（1.8）
输尿管低级别尿路上皮癌	1（1.8）
前列腺癌	1（1.8）
肾移植术后	4（7.1）
先天性孤立肾	1（1.8）
其他	3（5.4）
狭窄侧[例(%)]
单侧	41（73.2）
双侧	15（26.8）
狭窄长度[cm，M(Q_min～Q_max)]	5.1（0.5～25.0）
尿液白细胞[个/μl，M(Q_min～Q_max)]	62（0～20 964）
尿液亚硝酸盐[例(%)]
（-）	5（8.9）
（+）	51（91.9）
术前血肌酐[μmol/L，M(Q_min～Q_max)]	117（54～966）
术前肾盂分离[mm，(±s)]	（29±9）
术前长期留置双J管时间[月，M(Q_min～Q_max)]	12（0～72）

变量	结果
手术时间[min，M(Q_min～Q_max)]	60（25～335）
术中出血[ml，M(Q_min～Q_max)]	5（0～50）
支架数量（≥2根）[例(%)]	20（21.3）
术后住院时间[d，M(Q_min～Q_max)]	4（1～29）
术后留置肾造瘘管[d，M(Q_min～Q_max)]	2.5（1.0～11.0）
随访时间[月，(±s)]	（11±6）
末次随访血肌酐[μmol/L，M(Q_min～Q_max)]	103（56～317）
末次随访肾盂分离[mm，(±s)]	（18±7）
术后并发症[例(%)]
尿路刺激	6（1.07）
腰痛	8（14.29）
支架移位	1（1.79）

变量	结果
手术时间[min，M(Q_min～Q_max)]	60（25～335）
术中出血[ml，M(Q_min～Q_max)]	5（0～50）
支架数量（≥2根）[例(%)]	20（21.3）
术后住院时间[d，M(Q_min～Q_max)]	4（1～29）
术后留置肾造瘘管[d，M(Q_min～Q_max)]	2.5（1.0～11.0）
随访时间[月，(±s)]	（11±6）
末次随访血肌酐[μmol/L，M(Q_min～Q_max)]	103（56～317）
末次随访肾盂分离[mm，(±s)]	（18±7）
术后并发症[例(%)]
尿路刺激	6（1.07）
腰痛	8（14.29）
支架移位	1（1.79）

	血肌酐[μmol/L，M(Q_min～Q_max)]	肾盂分离[mm，(±s)]
术前	117（54～966）	29±9
术后	103（56～317）	18±7
统计值	Z=-2.941	t=8.838
P值	<0.001	<0.001

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