Role of Preoperative Ureteric Stenting in Optimization of Patients with Retroperitoneal Tumors Associated with Obstructive Uropathy
Tóm tắt
Retroperitoneal tumors can cause ureteric obstruction leading to obstructive uropathy. Early preoperative ureteric stenting helps to improve renal function and also helps in identifying ureters and prevent ureteric injury during surgery. This study was aimed at assessing the outcome of preoperative stenting in optimizing such patients. A total of 24 cases were enrolled. Of these, 15 patients who had obstructive uropathy were taken for ureteric stenting preoperatively and other 9 patients have undergone surgery without stenting. Twelve patients were stented successfully but 3 patients could not be stented (underwent percutaneous nephrostomy). All 24 patients underwent laparotomy, and of the 12 stented patients, 11 underwent successful resection and one had unresectable tumor. The patient’s serum creatinine was assessed initially and then twice after stenting (48 h and 5 days). Serum creatinine was also estimated 24 h after excision of the tumor. In the successfully stented and operated patients, mean initial creatinine was 7.85. The mean creatinine at 48 h and 5 days after stenting was 4.29 and 1.19 respectively. The mean creatinine 24 h after resection of the tumor was 1.04. Of the non-stented patients, 3 had ureteric injury during surgery. We conclude that preoperative ureteric stenting is helpful for optimization of patients with retroperitoneal tumors with obstructive uropathy.
Tài liệu tham khảo
Van Roggen JF, Hogendoorn PC (2000) Soft tissue tumours of the retroperitoneum. Sarcoma 4:17–26
Kotilingam D, Lev DC, Lazar AJ, Pollock RE (2006) Staging soft tissue sarcoma : evolution and change. CA Cancer J Clin 56:282–291
Strauss DC, Hayes AJ, Thomas JM (2011) Retroperitoneal tumours:review of management. Ann R Coll Surg Engl 93:275–280
Strauss DC, Hayes AJ, Thway K, Moskovic EC, Fisher C, Thomas JM (2010) Surgical management of primary retroperitoneal sarcoma. Br J Surg 97:698–706
Delacroix SE Jr, Winters JC (2010) Urinary tract injuries: recognition and management. Clin Colon Rectal Surg 23:104–112
McGrath PC (1994) Retroperitoneal sarcomas. Semin Surg Oncol 10:364–368
Herman K, Kusv T (1999) Retroperitoneal sarcoma – the continued challenge for surgery and oncology. Surg Oncol 7:77–81
Hassan I, Park SZ, Donohue JH, Nagorney DM, Kay PA, Nasciemento AG, Schleck CD, Ilstrup DM (2004) Operative management of primary retroperitoneal sarcomas – a reappraisal of an institutional experience. Ann Surg 239:244–250
Lewis JJ, Leung D, Woodruff JM, Brennan MF (1998) Retroperitoneal soft tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 228:355–365
Vaughan ED Jr, Sorenson EJ, Gillenwater JY (1970) The renal haemodynamic response to chronic unilateral complete ureteral occlusion. Investig Urol 8:78–90
Ryan PC, Maher KP, Murphy B, Hurley GD, Fitzpatrick JM (1987) Experimental partial ureteral obstruction: pathophysiological changes in upper tract pressures and renal blood flow. J Urol 138:674–678
Shokeir AA, Shoma AM, Abubieh EA, Nasser MA, Eassa W, El-Asmy A (2002) Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index. Urology 59:506–510
Ringel A, Richter S, Shalev M, Nissenkorn I (2000) Late complications of ureteral stents. Eur Urol 38:1–4
Gillenwater JY (1992) The pathophysiology of urinary obstruction. In: Walsh PC, Gittes, Perlumutter, Stamey (eds) Campbell’s Urology, 5th edn. Saunders Co., Philadelphia, pp 499–532
Wenzler DL, Kim SP, Rosevear HM, Faerber GJ, Roberts WW, Wolf, Jr JS (2008) Success of ureteral stents for intrinsic ureteral obstruction. J Endourol 22:295–299
Docimo SG, Dewolf WC (1989) High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions. J Urol 42:277–279
Chung SY, Stein RJ, Landsittel D et al (2004) 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol 17:592–595
Yossepowitch O, Lifshitz DA, Dekel Y et al (2001) Predicting the success of retrograde stenting for managing ureteral obstruction. J Urol 166:1746–1749
Izumi K, Mizokami A, Maeda Y, Koh E, Namiki M (2011) Current outcome of patients with ureteral stents for the management of malignant ureteral obstruction. J Urol 185:556–561
Pearle MS, Pierce HL, Miller GL et al (1998) Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 160:1260–1264
Feng MI, Bellman GC, Shapiro CE (1999) Management of ureteral obstruction secondary to pelvic malignancies. J Endourol 13:521–524
Donat MS, Russo P (1996) Ureteral decompression in advanced non-urologic malignancies. Ann Surg Oncol 3:393–399
Lee F, Huang TS, Ng XY, Ko WC, Liu CL, Lin JC (2017) Surgical management of primary retroperitoneal tumours-analysis of a single-center experience. J Cancer Res Pract 1–4
Hyams ES, Shah O (2008) Malignant extrinsic ureteral obstruction: a survey of urologists and medical oncologists regarding treatment patterns and preferences. Urology 72:51–56
Ku JH, Lee SW, Jeon HG, Kim HH, Oh SJ (2004) Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences? Urology 64:895–899
Song Y, Fei X, Song Y (2012) Percutaneous nephrostomy versus indwelling ureteral stent in the management of gynecological malignancies. Int J Gynecol Cancer 22:697–702
Hsu L, Li H, Pucheril D, Hansen M, Littleton R, Peabody J, Sammon J (2016) Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol 5:172–181
Holden S, McPhee M, Grabstald H (1979) The rationale of urinary diversion in cancer patients. J Urol 121:19–21
Andriole GL, Bettmann MA, Garnick MB, Richie JP (1984) Indwelling double-J ureteral stents for temporary and permanent urinary drainage: experience with 87 patients. J Urol 131:239–241
Bose B, Boake RC (1976) Obstuctive uropathy due to primary retroperitoneal tumour (leiomyosarcoma): report of 2 cases and review of literature. Br J Surg 63:934–940