Abstract No. 163: Retrievable metal stents in management of benign ureteric strictures: A feasibility study

Abstract

To evaluate the safety and efficacy of retrievable stent in management of persistent benign ureteric stricture. Eight patients with post-operative ureteric stricture that did not respond to balloon dilatation were included in the study. Nine retrievable wall flex covered metal stent were placed for at least 4 weeks to keep stricture patent. The stents were removed using endoscopy forceps percutaneously after 4 weeks and stricture was assessed for response to treatment. Eight stents were placed by antegrade approach through existing nephrostomy access and one stent was placed through retrograde approach through ileal conduit. Technical success was achieved in five of the six patients whom retrieval was attempted. Four were removed percutaneously by antegrade approach through the nephrostomy access and one stent was placed and removed by retrograde approach through the ileal conduit. In two patients stent could not be retrieved by antegrade approach in the interventional radiology suite due to fracture of retrieval loop and crimpling of the stent. One of stent was left in renal pelvis and it was removed via the percutaneous route in the operating room using rigid nephroscope and rigid forceps. The other patient stent was left in ureter and NU catheter was placed through the stent. Two patients had no hydronephrosis after removal of stent in follow up imaging, one patient has persistence of stricture and one patient with transplant kidney and anastomotic stricture developed complete occlusion of the lower ureter. One patient was lost to follow-up however immediate post removal nephrostogram shows significant improvement. Retrievable metal stents can be placed across ureteric stricture (100%) and retrieved (83.3%) by both antegrade and retrograde approach with high success rate. Improvement of ureteric stricture was observed in three patients, persistence of stricture in one patient and worsening in one patient. Patients with uretero-enteric anastomostic stricture following radical cystectomy responded well however there was worsening of stricture in a transplant patient with ureteric anastomotic stricture.