Nonoperative supravesical urinary diversion in obstetrics and gynecology

Abstract

Twenty-five patients with ureteral obstruction caused by malignant or benign obstetrical or gynecological conditions were managed by nonoperative measures using indwelling ureteral stents. Bilateral obstruction was present in 15 patients. Immediate indications for stent placement were azotemia or uremia in 11, pain in 8, and preservation of function in 6. Four patients who failed endoscopie ureteral stent placement had successful percutaneous nephrostomy placement and one of these was converted to internal ureteral diversion through a percutaneous nephrostomy. Indwelling ureteral stents were generally well tolerated. Seven had to be replaced from 4 to 12 weeks after placement because of occlusions of the catheters by debris. The length of stent placement ranged from 1 month to 21 months. Three different types of commercially available stents were used (Gibbons, Cook double pigtail, Finney double J). Local anesthesia was utilized in the majority of cases. Protection and improvement in renal function has allowed radiotherapy and longterm chemotherapy to progress in several patients with Stage IV carcinoma of the cervix. Three are in complete remission and have had successful removal of the ureteral stents. Several other patients have been able to return to normal homemaking for significant periods of time.