输尿管支架在肾移植中的应用

钟崔宇; 王於尘; 刘如敏; 苗芸

doi:10.3969/j.issn.1674-7445.2023.03.020

输尿管支架在肾移植中的应用

doi: 10.3969/j.issn.1674-7445.2023.03.020

510515 广州，南方医科大学南方医院器官移植科

基金项目:

国家自然科学基金 82270784

国家自然科学基金 82070770

广东省自然科学基金 2020A1515010674

南方医院院长基金 2018C003

详细信息

作者简介:

通讯作者:
苗芸（ORCID：0000-0003-3592-4695），博士，主任医师，研究方向为肾移植，Email：miaoyunecho@126.com

中图分类号: R617, R692
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出版历程
- 收稿日期: 2022-12-31
- 刊出日期: 2023-05-15

Application of ureteral stent in kidney transplantation

Department of Organ Transplantation, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China

More Information

Corresponding author: Miao Yun, Email: miaoyunecho@126.com

摘要

摘要: 肾移植术后易发生输尿管狭窄、尿漏等泌尿系统并发症，严重影响移植肾功能，甚至导致移植肾丢失。输尿管支架在肾移植中发挥着重要作用，其通过促进肾移植术后尿液从肾脏流入膀胱，减轻输尿管内压力，降低早期泌尿系统并发症的发生风险，但也可能造成尿路感染、支架相关并发症和BK病毒感染等不利影响。因此临床医师需要灵活把握输尿管支架移除指征。本文对肾移植领域输尿管支架的应用、可能带来的不利影响及移除时机做一综述，旨在为肾移植术后输尿管支架相关的临床决策提供参考。
- 输尿管支架 /
- 肾移植 /
- 尿漏 /
- 输尿管狭窄 /
- 尿路感染 /
- 支架移除 /
- BK病毒感染 /
- 支架相关并发症
Abstract: Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.
- Ureteral stent /
- Kidney transplantation /
- Urine leakage /
- Ureteral stricture /
- Urinary tract infection /
- Stent removal /
- BK virus infection /
- Stent-related complication

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表 1 不同类型输尿管支架特点

Table 1. Characteristics of different types of ureteral stents

设计类型	特点
传统双J支架	通用设计，降低迁移风险
环形支架	提供更好的患者舒适度
网状支架	上尿路感染的发生率较低
螺旋支架	更好地排尿和排出结石
流线型侧孔支架	通过增加腔内外隔室之间的流体交换来减少颗粒沉积

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参考文献(37)

[1]	KIRNAP M, BOYVAT F, TORGAY A, et al. Incidence of urinary complications with double J stents in kidney transplantation[J]. Exp Clin Transplant, 2019, 17(Suppl 1): 148-152. DOI: 10.6002/ect.MESOT2018.P14.
[2]	XIA K, ZHONG W, CHEN J, et al. Clinical characteristics, treatment strategy, and outcomes of primary large cell neuroendocrine carcinoma of the bladder: a case report and systematic review of the literature[J]. Front Oncol, 2020, 10: 1291. DOI: 10.3389/fonc.2020.01291.
[3]	DOHERTY DT, MOINUDDIN Z, GREY BR, et al. Isiris^TM for ureteric stent removal in renal transplantation: an initial single-centre experience of 150 cases[J]. Surg Innov, 2021, 28(3): 366-370. DOI: 10.1177/15533506211007268.
[4]	MATHIAS S, WISEMAN O. Silicone vs. polyurethane stent: the final countdown[J]. J Clin Med, 2022, 11(10): 2746. DOI: 10.3390/jcm11102746.
[5]	MOSAYYEBI A, VIJAYAKUMAR A, MOSAYEBI M, et al. The accumulation of particles in ureteric stents is mediated by flow dynamics: full-scale computational and experimental modeling of the occluded and unoccluded ureter[J]. APL Bioeng, 2022, 6(2): 026102. DOI: 10.1063/5.0083260.
[6]	RAMACHANDRA M, MOSAYYEBI A, CARUGO D, et al. Strategies to improve patient outcomes and qol: current complications of the design and placements of ureteric stents[J]. Res Rep Urol, 2020, 12: 303-314. DOI: 10.2147/RRU.S233981.
[7]	BHARDWAJ M, INGOLE N. Application, advancement, and complication of ureteral stent and encrustation: a major complication[J]. Cureus, 2022, 14(8): e28639. DOI: 10.7759/cureus.28639.
[8]	SHAH M, PILLAI S, CHAWLA A, et al. A randomized trial investigating clinical outcomes and stent-related symptoms after placement of a complete intra-ureteric stent on a string versus conventional stent placement[J]. BJU Int, 2022, 129(3): 373-379. DOI: 10.1111/bju.15540.
[9]	BOSIO A, ALESSANDRIA E, AGOSTI SC, et al. Loop-tail stents fail in reducing stent-related symptoms: results of a prospective randomised controlled trial[J]. BJU Int, 2022, 129(1): 123-129. DOI: 10.1111/bju.15395.
[10]	陈智威. 输尿管支架在输尿管狭窄治疗中的应用进展[J]. 中国微创外科杂志, 2022, 22(4): 333-337. DOI: 10.3969/j.issn.1009-6604.2022.04.010. CHEN ZW. Application of ureteral stent in the treatment of ureteral stricture[J]. Chin J Min Inv Surg, 2022, 22(4): 333-337. DOI: 10.3969/j.issn.1009-6604.2022.04.010.
[11]	SHAN H, CAO Z, CHI C, et al. Advances in drug delivery via biodegradable ureteral stent for the treatment of upper tract urothelial carcinoma[J]. Front Pharmacol, 2020, 11: 224. DOI: 10.3389/fphar.2020.00224.
[12]	LUNDEEN CJ, FORBES CM, WONG VKF, et al. Ureteral stents: the good the bad and the ugly[J]. Curr Opin Urol, 2020, 30(2): 166-170. DOI: 10.1097/MOU.0000000000000701.
[13]	KAPOOR A, AKERMAN J, WONG ECL, et al. Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: a randomized controlled trial[J]. Can Urol Assoc J, 2021, 15(2): E97-E102. DOI: 10.5489/cuaj.6684.
[14]	ZHONG Q, SONG T, ZENG J, et al. Initial experiment of self-expanding metal ureteral stent in recurrent ureteral stenosis after kidney transplantation[J]. Am J Transplant, 2021, 21(5): 1983-1984. DOI: 10.1111/ajt.16444.
[15]	MENDEZ-PROBST CE, GONEAU LW, MACDONALD KW, et al. The use of triclosan eluting stents effectively reduces ureteral stent symptoms: a prospective randomized trial[J]. BJU Int, 2012, 110(5): 749-754. DOI: 10.1111/j.1464-410X.2011.10903.x.
[16]	LEE J, KATZ M, SHAH O. Developments in ureteral stent technology[J]. Front Surg, 2021, 8: 764167. DOI: 10.3389/fsurg.2021.764167.
[17]	WILSON CH, RIX DA, MANAS DM. Routine intraoperative ureteric stenting for kidney transplant recipients[J]. Cochrane Database Syst Rev, 2013(6): CD004925. DOI: 10.1002/14651858.CD004925.pub3.
[18]	MOSQUEDA AO, HERNÁNDEZ EEL, MORALES GC, et al. Association between the placement of a double-J catheter and the risk of urinary tract infection in renal transplantation recipients: a retrospective cohort study of 1038 patients[J]. Transplant Proc, 2021, 53(6): 1927-1932. DOI: 10.1016/j.transproceed.2021.05.002.
[19]	VISSER IJ, VAN DER STAAIJ JPT, MUTHUSAMY A, et al. Timing of ureteric stent removal and occurrence of urological complications after kidney transplantation: a systematic review and meta-analysis[J]. J Clin Med, 2019, 8(5): 689. DOI: 10.3390/jcm8050689.
[20]	SUÁREZ FERNÁNDEZ ML, RIDAO CANO N, ÁLVAREZ SANTAMARTA L, et al. A current review of the etiology, clinical features, and diagnosis of urinary tract infection in renal transplant patients[J]. Diagnostics (Basel), 2021, 11(8): 1456. DOI: 10.3390/diagnostics11081456.
[21]	LEE JH, MUTHUKUMAR T, KIM J, et al. Antibiotic prophylaxis for ureteral stent removal after kidney transplantation[J]. Clin Transplant, 2019, 33(3): e13491. DOI: 10.1111/ctr.13491.
[22]	BRITT NS, HAGOPIAN JC, BRENNAN DC, et al. Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation[J]. Nephrol Dial Transplant, 2017, 32(10): 1758-1766. DOI: 10.1093/ndt/gfx237.
[23]	ALWESALI SM. A long forgotten ureteral stent for 13 years post renal transplantation[J]. Urol Case Rep, 2022, 44: 102156. DOI: 10.1016/j.eucr.2022.102156.
[24]	XIE D, HU C, GU D, et al. Experiences in managing different consequences of forgotten ureteral stents[J]. Urol Ann, 2022, 14(2): 141-146. DOI: 10.4103/UA.UA_165_20.
[25]	MARTÍNEZ MORENO AI, GUIMERÀ GARCIA J, RIERA MARI V, et al. Prevalence of BK virus in renal transplant at a single center: experience with our ureteral reimplantation surgical technique[J]. Exp Clin Transplant, 2020, 18(4): 458-462. DOI: 10.6002/ect.2019.0425.
[26]	HASHIM F, REHMAN S, GREGG JA, et al. Ureteral stent placement increases the risk for developing bk viremia after kidney transplantation[J]. J Transplant, 2014: 459747. DOI: 10.1155/2014/459747.
[27]	SIPARSKY NF, KUSHNIR LF, GALLICHIO MH, et al. Ureteral stents: a risk factor for polyomavirus BK viremia in kidney transplant recipients undergoing protocol screening[J]. Transplant Proc, 2011, 43(7): 2641-2644. DOI: 10.1016/j.transproceed.2011.06.034.
[28]	FUJITA A, KOBATAKE K, FUKUSHIMA T, et al. Successful treatment of BK virus-associated severe hemorrhagic cystitis with bilateral single-J ureteral stenting[J]. IJU Case Rep, 2022, 5(4): 242-245. DOI: 10.1002/iju5.12445.
[29]	SOYLU L, AYDIN OU, ATLI M, et al. Does early removal of double J stents reduce urinary infection in living donor renal transplantation?[J]. Arch Med Sci, 2019, 15(2): 402-407. DOI: 10.5114/aoms.2018.73524.
[30]	GEORGIADES F, SILVA ANS, PUROHIT K, et al. Outpatient ureteric stent removal following kidney transplantation[J]. Br J Surg, 2022, 109(2): 152-154. DOI: 10.1093/bjs/znab223.
[31]	SCHNEIDEWIND L. Benefits and risks of early versus late ureteric stent removal after kidney transplantation[J]. Urologe A, 2019, 58(2): 168-171. DOI: 10.1007/s00120-019-0856-y.
[32]	PATEL P, REBOLLO-MESA I, RYAN E, et al. Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal[J]. Am J Transplant, 2017, 17(8): 2129-2138. DOI: 10.1111/ajt.14223.
[33]	RODRÍGUEZ FABA O, BOISSIER R, BUDDE K, et al. European association of urology guidelines on renal transplantation: update 2018[J]. Eur Urol Focus, 2018, 4(2): 208-215. DOI: 10.1016/j.euf.2018.07.014.
[34]	YUKSEL Y, TEKIN S, YUKSEL D, et al. Optimal timing for removal of the double-J stent after kidney transplantation[J]. Transplant Proc, 2017, 49(3): 523-527. DOI: 10.1016/j.transproceed.2017.01.008.
[35]	DADKHAH F, YARI H, ALI ASGARI M, et al. Benefits and complications of removing ureteral stent based on the elapsed time after renal transplantation surgery[J]. Nephrourol Mon, 2016, 8(2): e31108. DOI: 10.5812/numonthly.31108.
[36]	WINGATE JT, BRANDENBERGER J, WEISS A, et al. Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation[J]. Transpl Infect Dis, 2017, 19(1). DOI: 10.1111/tid.12644.
[37]	PARK J, LEE SY, LEE HS, et al. The impact of prophylactic ureteral stenting during kidney transplantation on postoperative surgical outcomes[J]. Korean J Transplant, 2021, 35(1): 41-47. DOI: 10.4285/kjt.20.0050.