Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

IF 1.4 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Diagnostic and interventional radiology Pub Date : 2024-07-08 Epub Date: 2023-06-05 DOI:10.4274/dir.2023.232129
Selin Ardalı Düzgün, Emre Ünal, Türkmen Turan Çiftçi, Ebru Öztürk, Okan Akhan, Devrim Akıncı
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引用次数: 0

Abstract

Purpose: To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome.

Methods: Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution.

Results: The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0–19th day following the surgery.

Conclusion: IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.

介入放射学在治疗先天性尿路损伤中的作用:影响疗效的因素
目的:评估介入放射学(IR)治疗先天性尿路损伤的疗效,并研究影响疗效的因素:本研究共纳入 58 名因先天性尿路损伤转诊的患者(21 名男性),平均年龄为 50.3 ± 15.8 岁。技术成功的定义是:(i) 在肾盂内成功置入肾造瘘导管和/或 (ii) 在肾盂和膀胱腔之间成功逆行置入输尿管支架(双 J 支架)。完全缓解的定义是在没有外引流管和输尿管支架的情况下保持输尿管通畅。此外,还调查了可能影响完全缓解的因素[输尿管撕脱、输尿管阴道瘘(UVF)、恶性肿瘤/放疗史以及接受红外治疗的时间]。通过接收者操作特征分析,估算出影响完全缓解的红外治疗时间的临界点:结果:肾造瘘术和输尿管支架置入术的技术成功率分别为 100%(n = 58/58)和 78%(n = 28/36)。14例患者的肾盂肾盏系统明显未扩张。在 18 例患者中,经皮肾造瘘术后未进行进一步干预,原因是:(i) 表现不佳(6 例);(ii) 应临床医生和/或患者的要求进行了重建手术(12 例)。其余 40 例患者中有 11 例因经皮治疗失败而需要进行重建手术(n = 11/40,27.5%)。其中 6 名患者因出现输尿管良性狭窄而无法取出输尿管支架(n = 6/40,15%)。完全治愈率为 57.5%(23/40)。年龄、性别、手术类型(内窥镜或开放手术)、损伤侧和损伤位置对完全缓解率没有统计学影响。输尿管撕脱伤、恶性肿瘤病史和放疗单独或合并存在时,会对完全缓解率产生明显的负面影响。存在紫外线场也会对完全缓解率产生负面影响,但没有达到统计学意义。延迟干预也是降低完全缓解率的一个重要因素。结论:红外线手术在白内障手术中是安全有效的:结论:红外线手术治疗先天性尿路损伤安全有效。应尽快进行输尿管前路支架植入术,以确保输尿管的完整性,避免出现狭窄。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diagnostic and interventional radiology
Diagnostic and interventional radiology Medicine-Radiology, Nuclear Medicine and Imaging
自引率
4.80%
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0
期刊介绍: Diagnostic and Interventional Radiology (Diagn Interv Radiol) is the open access, online-only official publication of Turkish Society of Radiology. It is published bimonthly and the journal’s publication language is English. The journal is a medium for original articles, reviews, pictorial essays, technical notes related to all fields of diagnostic and interventional radiology.
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