tailieunhanh - CURRENT CLINICAL UROLOGY - PART 6

Tương tự như vậy, Hwang và đồng nghiệp (56), trong một nghiên cứu trước đây cho biết họ đã tốt hơn tỷ lệ thành công chung với ống đỡ động mạch endopyelotomy 14 / 7 so với các ống đỡ động mạch 6-Cha niệu quản nội bộ (93,3 và 84%, tương ứng). Tuy nhiên, sự khác biệt trong tỷ lệ thành công không có ý nghĩa thống kê. | Chapter 10 Antegrade Endopyelotomy 173 short-term 83 vs 94 respectively and long-term 71 and 93 respectively success rates in patients in whom a modified 27 14 nephroureteral stent was placed compared to patients who had the standard 14 graduated. Similarly Hwang and co-workers 56 in an earlier study reported they had better overall success rates with the 14 7 endopyelotomy stent compared to the 6-Fr internal ureteral stent and 84 respectively . However the difference in success rate was not statistically significant. Accommodating these large diameter stents often require placing a double-J stent to dilate the ureter for several days in order to decrease the difficulty of inserting the larger endopy-elotomy stent down the ureter or as Danuser and co-workers have done making a 3 to 5 cm incision that extended well into the normal renal pelvis and ureter. Some feel that a stent serves as a mold around which healing takes place and that the largest possible diameter stent is preferable to induce formation of a sufficient caliber lumen but without causing ischemia. Others believe that the stent acts as a scaffold to orient regenerating muscle fibers and therefore a smaller caliber stent is just as effective. Several retrospective nonrandomized series have demonstrated comparable success rates using standard size stents. Stent size has been considered an insignificant factor based on two animal studies that showed no significant difference in success using 7- or 14-Fr and 7- or 12-Fr stents respectively 10 59 as well as in clinical studies 14 27 29 . Thus only a prospective randomized study comparing large diameter stents to standard caliber stents using universally accepted criteria for obstruction will answer the question of optimal stent size after endopyelotomy definitively. Most urologists leave the stent in place for 6 weeks based on initial animal studies showing 90 regeneration of smooth muscle and muscular continuity within 6 to 7 weeks of .

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