Meta-analysis of perioperative results and safety of percutaneous nephrostomy and retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection / 中华泌尿外科杂志

Objective:To compare the perioperative outcomes and safety of percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS) in the treatment of acute obstructive upper urinary tract infection.Methods:A comprehensive search was performed on the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify relevant literatures. The retrieval period was from the establishment of the database to August 2022. Inclusion criteria: ①Randomized controlled trial (RCT) of PCN and RUS in the treatment of acute obstructive upper urinary tract infection; ②Studies provided accurate data for analysis, including the total number of subjects and the results of each index; ③The full text of the study was available, and different literatures published in the same cohort were included in the newly published data. ④The observation indexes included the time for the recovery of body temperature, creatinine, leukocyte, operation, radiation exposure, postoperative fever, postoperative pain, and the incidence of postoperative fistulotomy or stent displacement. Exclusion criteria: ①non-RCT study; ②unable to obtain the full text. Two researchers independently screened the literature and evaluated the literature quality, and all the statistical data were analyzed by RevMan5.3 software.Results:Seven trials enrolled 727 patients were included in the meta-analysis, 412 in the PCN group and 315 in the RUS group included. Meta-analysis revealed that the advantages of PCN were lower incidence of postoperative hematuria ( OR=0.54, 95% CI 0.30-0.99, P=0.040) and lower incidence of insertion failure ( OR=0.42, 95% CI 0.21-0.81, P=0.010), but the fluoroscopy time of RUS group was shorter than that of PCN group ( MD=0.31, 95% CI 0.14-0.48, P<0.01). Moreover, there was no significant difference in time to normalization of temperature, time to normalization of creatinine, time to normalization of WBC, operative time, postoperative fever, postoperative pain, postoperative nephrostomy tube or stent slippage rate between the two surgical methods( P>0.05). Conclusions:The radiation exposure time of PCN was longer than that of RUS, but the incidence of postoperative hematuria and catheterization failure was lower than that of RUS.

Risk factors and pathogen distribution of urinary tract infection after ureteral stenting in urological patients / 中华临床感染病杂志

Objective To investigate the risk factors and pathogen distribution of urinary tract infection after ureteral stenting in urological patients.Methods Eighty-four patients, who underwent ureteral stenting in Department of Urology of the Second Hospital of Tianjin Medical University from January 2017 to December 2018, developed urinary tract infection within 2 weeks after ureteral stenting ( infection group).One hundred and sixty-eight patients with ureteral stenting and without urinary tract infection were matched by gender, age (within 3 years old) and catheterization time ( 30 d) as the control group.The Cox regression analysis was performed to identify the risk factors of urinary tract infection after ureteral stenting . The pathogenic distribution and drug resistance of the strains in the case group were analyzed .Results Univariate analysis showed that the use of hormones , multiple urinary stones, the size of stones ≥2 cm in diameter, history of previous stones , residual stones after catheterization , urinary tract infections one month before catheterization, elevated peripheral blood leukocytes , and increased neutrophil proportion and decreased serum albumin were significantly associated with urinary tract infection after ureteral stent placement (all P ＜0.05).Cox multivariate analysis showed that the history of previous stones ( OR ＝5.689, 95%CI 1.944－16.652, P＜0.01), residual stones after catheterization ( OR＝7.660, 95%CI 3.371－17.409, P ＜0.01 ) and increased proportion of neutrophils ( OR ＝5.586, 95%CI 2.410 －12.949, P＜0.01) were independent risk factors for urinary tract infection after ureteral stent placement in urological patients.All 84 patients had single infection , and total 84 pathogens were isolated, of which Escherichia coli was most prevalent ( 28.57%, 24／84 ).Escherichia coli has a high resistance rate to compound sulfamethoxazole , levofloxacin, ampicillin and ceftriaxone (all＞60.00%); while the sensitivity rate of Escherichia coli to ertapenem, imipenem and tigecycline were all 100.00%, and the resistance rates to other antimicrobial agents were ＜30.00%.Conclusion Reducing the incidence and recurrence of urinary stones and the residual stones after surgery as well as the proportion of patients with neutrophils can decrease the risk of urinary tract infection in patients after ureteral stenting.Escherichia coli is the main pathogen causing urinary tract infection after ureteral stenting.

Nursing care for patients receiving percutaneous antegrade ureteral stent implantation for ureteral stricture / 介入放射学杂志

Objective To discuss the nursing measures for patients who are receiving percutaneous antegrade ureteral stent implantation for ureteral stricture.Methods A total of 35 patients with ureteral stricture,who were treated with percutaneous antegrade ureteral stent implantation,were included in this study.The nursing care for these patients included the following measures:comprehensive preoperative ward nursing and nutritional support therapy;active preparation,cooperation and monitoring of vital signs during operation;strict postoperative dietary guidance,body position guidance,observation and nursing of complications,and discharge guidance.Results Successful implantation of ureteral stent with single procedure was accomplished in all 35 patients.Mter the procedure,the renal function was markedly improved,when compared with the preoperative data the difference was statistically significant (P＜0.05).The complications,including soreness of waist,lumbago,bladder irritation,hematuria,urinary tract infection,etc.were effectively relieved by positive nursing intervention measures.Conclusion Comprehensive,thoughtful and meticulous nursing care is an important guarantee to ensure a successful percutaneous antegrade ureteral stent implantation for ureteral stricture as well as to reduce the postoperative complications.(J Intervent Radiol,2017,26:277-280)

Effective Predicting Succes Factors of Retrograde Ureteral Stenting in Patients with Malignant Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: We have endeavored to find the factors predicting the success of ureteral stenting before cystoscopic retrograde ureteral catheterization in the patients with malignant ureteral obstruction. MATERIALS AND METHODS: 38 patients(51 kidneys) were analyzed, who were treated by retrograde ureteral stenting or percutaneous nephrostomy due to ureteral obstruction in non-urologic malignancy during the past 3 years. The sorts of primary tumors were cervix cancer in 14 cases(18 kidneys), stomach cancer in 12 cases(18 kidneys), colo-rectal cancer in 7 cases(9 kidneys), ovary cancer in 4 cases(5 kidneys), and endometrial cancer in 1 case(1 kidney). The cause of the ureteral obstruction was direct tumor invasion in 26 kidneys, lymphadenopathy in 23 kidneys and post radiation therapy in 2 kidneys. Retrograde ureteral stenting had failed in 22 kidneys(ureteral orifice could not be found in 14 kidneys, guide wire could not be advanced in 8 kidneys). RESULTS: Among the 51 kidneys, 29 kidneys(57%) were succeeded, and 22 kidneys(43%) were failed in retrograde ureteral catheterization. In fourteen of 22 kidneys(64%) ureteral orifice could not identified due to hemorrhage and edema of mucosa of bladder, and in 8 kidneys(36%) ureteral catheter could not be advanced to the renal pelvis. The cause of failure of the retrograde ureteral catheterization were direct tumor invasion in 10/26 kidneys(39%), and lymphnode enlargement in 4 of 23 kidneys(17%)(p=0.0007). According to the presence of ureteral obstructive symptoms, 8/29 kidneys(28%) were with the presence of ureteral obstruction symptoms, whereas 14/22 kidneys(64%) were failed with the absence of ureteral obstructive symptoms(p=0.0051). Of the obstruction site, 4/21 kidneys(19%) of upper to mid ureteral obstruction and 18/30 kidneys(79%) of lower ureteral obstruction were failed(p=0.0056). Of the degree of hydronephrosis, 18/47 kidneys(38%) of mild to moderate degree of hydronephrosis and 4/4 kidneys(100%) of severe hydronephrosis were failed(p=0.0022). CONCLUSIONS: This study shows that direct tumor invasion to the ureter, asymptomatic ureteral obstruction, lower ureteral obstruction, and high grade hydronephrosis were regarded as a high failure factors for the retrograde ureteral catheterization. Thus, we should not hesitate to choose percutaneous nephrostomy, in such condition that makes difficult for retrograde ureteral catheterization in malignant ureteral obstruction patients.

A Case of Emphysematous Pyelonephritis Recovered by Ureteral Stenting / 대한비뇨기과학회지

A 62-year-old diabetic male was presented with abdominal pain. Six years ago, he had been performed cystectomy with both cutaneous ureterostomy for bladder cancer. After admission, high fever was developed and radiologic findings revealed a calcification occupying the whole left pelvocalyceal system with gas accumulation in parenchyme. We started the intensive cares with fluid therapy, broad-spectrum antibiotics and insulin therapy, but he failed to improve with supportive management. For the decompression we placed initially double-J stent through the left cutaneous ureterostomy instead of percutaneous nephrostomy or nephrectomy. After stenting, postobstructive diuresis was occurred and followed by marked improvement in general condition including vital sign, mental status and laboratory findings. Herein, we report a case of emphysematous pyelonephritis recoverd by ureteral stenting through the cutaneous ureterostomy in a diabetic patient with contralateral atrophic kidney.