Antegrade Ureteric Stent Insertion Research Articles

Outright antegrade ureteral stent insertion on an allograft kidney with angiomyolipoma with immediate obstructive uropathy posttransplant

Outright antegrade ureteral stent insertion on an allograft kidney with angiomyolipoma with immediate obstructive uropathy posttransplant

Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study

BackgroundUreteral double- J stent is usually inserted by retrograde approach to treating obstructed upper urinary tract. The antegrade approach, can be suitable alternative in certain situations without general or spinal anesthesia. The present study demonstrates the indications, success rate, and complications of this approach in treatmenting malignant obstructive uropathy. MethodsData of consecutive patients with malignant obstructive uropathy who underwent antegrade ureteral stenting in the Department of Interventional Radiology at Sahloul hospital from January 2013 to February 2020 was retrieved and retrospectively analyzed. ResultA total of 188 attempts of antegrade ureteral stent insertion was performed during the study period (left side = 78, right side = 82, bilateral = 14). The mean age was 54 years (range: 9–91 years). The indication of the antegrade stenting was the failure of retrograde approach in 63 patients.The single-stage approach was performed 103 times. A percutaneous nephrostomy was placed for the average duration of 22.4 days (range: 2–60 days) for subsequent attempts. Only four patients required general anesthesia. Ureteral obstruction was caused by bladder cancer (n = 92), uterine cancer (n = 31), prostate cancer (n = 28), colorectal cancer (n = 15) and retroperitoneal tumor (n = 8). A protective nephrostomy was left in situ in 44 cases for 48 h. Clinical success was achieved in 96% of the cases. Two and three patients required hospitalization for perirenal abscess and hematuria, respectively. ConclusionThis retrospective study shows that antegrade ureteral stent insertion has a high success rate with minimal complications. Trial registrationClinicalTrials.gov Identifier: NCT04649970. Registered december 2, 2020- Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT04649970;

Delayed Presentation of Urinoma Following Renal Transplant Biopsy: A Case Report

A urinoma is an unusual complication following renal transplant biopsy that can easily be missed or mistaken for a hematoma. In addition to trauma to the renal collecting system, a degree of urinary tract obstruction is required for urine to leak into the surrounding tissues and form a urinoma, which can in turn cause pressure on surrounding structures. This case report describes a patient who developed ipsilateral leg swelling several months after a renal transplant biopsy. Imaging demonstrated a perirenal transplant fluid collection, which biochemical analysis confirmed to be urine. This was successfully managed with percutaneous nephrostomy and antegrade ureteric stent insertion. The fluid collection persisted as a seroma however, and the patient proceeded to have peritoneal fenestration and marsupialization surgery. To our knowledge, this is the first reported case of urinoma complicating a renal transplant biopsy. This case highlights a diagnosis that can be easily missed and is therefore a potential pitfall for clinicians.

A case series of antegrade ureteric stent insertion using a novel technique

A case series of antegrade ureteric stent insertion using a novel technique

Extracorporeal Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty.

We aimed to evaluate a novel technique for ureteric stent insertion during dismembered pediatric laparoscopic pyeloplasty. Following identification and dissection of the ureteropelvic junction (UPJ) with the proximal part of ureter, the ureter is dismembered just proximal to the UPJ at the level of the renal pelvis, allowing use of the excess pelvic tissue for further manipulation of the ureter. Then the abdomen is desufflated and the ureter delivered to the skin level. The externalized ureter is then spatulated and the stent inserted in an antegrade fashion to the bladder. The first stitch for further laparoscopic anastomosis is applied to the lower part of the spatulated ureteric end and then following insufflations the ureter is returned to the abdomen. The laparoscopic anastomosis is completed in a routine fashion. Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2-18 years). Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes (range, 4-7 minutes). All stents were correctly placed. In one patient, the stent dislodged to distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning.

Percutaneous antegrade nephroscopic holmium laser pyelotomy: Novel endourologic technique for removal of extruded ureteral stent

Ureteral stent malposition outside of the urinary tract is a very uncommon complication of retrograde or antegrade ureteral stent insertion. There are few reports of open, laparoscopic or endourologic approaches to remove malpositioned stents. We present a novel technique for the removal of an extruded retroperitoneal ureteral stent using percutaneous antegrade nephroscopic holmium laser pyelotomy. This previously undescribed procedure represents a new soft tissue application of the holmium laser.

Placement of double-J ureteric stent using the pull-through technique in patients with tight ureteric stenosis

To evaluate the efficacy of antegrade insertion of the ureteric stent using pull-through technique in tight ureteric stricture that a guide-wire traversed, but a 5-F catheter could not. Seven patients (M:F = 2:5, mean age 56 years) who underwent antegrade ureteric stent insertion using pull-through technique due to tight ureteric stricture were retrospectively evaluated. The strictures were due to impacted ureter stone (n = 3), metastasis from rectal cancer (n = 1), and idiopathic ureter stricture (n = 3). After failing to traverse a 5-F catheter through the stricture along the guide-wire, a 7-F introducer sheath was inserted through the urethra. The distal end of the guide-wire was snared and retrieved through the urethral introducer sheath. Then using pull-through technique, antegrade ureteric stent insertion was performed. Double-J ureteric stent was successfully placed in all seven patients using the pull-through technique. Complications included abdominal/flank pain (n = 7), gross hematuria (n = 5) and elevated blood pressure (n = 1). All complications were relieved within 3 days after the procedure with conservative treatment. Antegrade double-J ureteric stent insertion using the pull-through technique is a safe and useful method, which can be used in tight ureteric strictures, where a ureteric stent cannot follow the passed guide wire.

Ureteral stent placement without postprocedural nephrostomy tube: experience in 41 patients.

To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube. Tubeless ureteral stent insertion was attempted in 41 (30 men, 11 women; eight, benign obstruction; nine outpatients) of 97 adults (56 excluded). Patients were clinically stable with known ureteral obstruction and had been referred for antegrade ureteral stent insertion. Exclusion criteria were infection, coagulopathy, or emergency cases. After renal access was achieved, ureteral stents were inserted. If drainage was satisfactory and there was no marked procedural bleeding, all access was removed without leaving a nephrostomy tube behind. Technical and clinical success rates and complications were assessed with review of radiologic and clinical notes. If one-stage stent insertion was unsuccessful, a nephrostomy tube was inserted and two-stage stent placement was performed. All 56 patients excluded from this study underwent two-stage stent placement. Major complication rate was assessed (Fisher test). One-stage stent insertion was technically successful in 36 (88%) patients; two with an identifiable risk factor (recent bladder operation, retrograde ureteral instrumentation) developed septicemia that required repeat nephrostomy tube insertion and 2-8 extra days of hospitalization. Clinical success rate was 83% (34 of 41). No major bleeding occurred. In 13 (36%) of 36 patients, hematuria lasted longer than 24 hours but resolved without further intervention or blood transfusion. In those who underwent two-stage stent placement (n = 61), technical success rate was 100%, but clinical success rate was 98%; one patient developed septicemia, and no major hemorrhage occurred. Difference in major complication rate between groups was not significant (6% [two of 36] vs 2% [one of 61]; P =.55). One-stage tubeless antegrade ureteral stent insertion in selected cases showed 88% technical success rate and 83% clinical success rate, with no major hemorrhage.

Primary Antegrade Ureteric Stenting: Prospective Experience and Cost-effectiveness Analysis in 50 Ureters

AIM: To evaluate the success rate and cost efficiency of primary antegrade ureteric stenting (antegrade ureteric stent insertion as a single procedure without preliminary drainage). MATERIALS AND METHODS: A policy of primary stenting was tested in 38 patients (50 ureters) with obstructive hydronephrosis, of acute or chronic onset and of benign or malignant origin. Patients with suspected pyonephrosis were excluded. Patients successfully primarily stented (group 1) were compared to a group stented as a traditional two-stage procedure (group 2). End point assessments were screening time, equipment used, procedure-related costs, bed occupancy and technical and clinical success rate. Using these cost and outcome measures, a cost-efficiency analysis was performed comparing the two strategies. RESULTS: 40/50 (80%) ureters were considered primary stent successes. The average procedure-related bed occupancy was 2 days (range 1–2 days). Simple equipment alone was successful in 16 cases. Van Andel dilatation catheters and peel-away sheaths were frequently used (23 ureters). Expensive equipment was rarely necessary (four cases) and average extra equipment cost was small (£46/case). The mean screening time was similar for the two groups (13.5 min vs 15.3 min;P⩾0.05). There was a minimum saving of £800 per successful primary stent. The cost-effectiveness of a primary antegrade stenting strategy was £1229 vs £2093 for secondary stenting. CONCLUSION: In carefully selected patients, the majority of obstructed ureters can be primarily stented using simple equipment. The reduced hospital stay and overall success rate significantly improves the cost competitiveness of antegrade ureteric stenting. Watson, G. M. T. and Patel, U.(2001)Clinical Radiology56, 568–574.

Inserción anterógrada de catéter ureteral

AbstractWe report twenty-four patients with urinary obstruction, in wich twenty-seven antegrade ureteral stent (double J) insertions were attemped (in six patients the obstruction was bilateral and in three other patients we failed).In all of them access to the urinary tract was through a nephrostomy catheter, in seventeen cases we proceeded to insert the antegrade catheter inmediatly after percutaneous nephrostomy and in ten remaining cases we achieved in a second try after carrying nephrostomy and failing a conventional retrograde approach to ureteral stent insertion.We got a 90-per cent success rate. A case of perirrenal hematoma occurred after applying a nephrostomy. It was the only relevant complication.In conclusion we consider that the antegrade ureteral stent insertion is a good alternative when, under several circumstances, the conventional retrograde insertion fails.

Combined percutaneous antegrade and cystoscopic retrograde approach in the treatment of distal ureteric fistulae.

To determine the efficacy of a cystoscopic approach, as definitive treatment of ureteral fistulae, after failure of antegrade ureteral stent insertion. Of 43 ureter fistulae encountered over 4 years, 10 postoperative and/or postradiotherapy fistulae could not be stented via an antegrade approach alone. A cystoscopic approach was used, with the antegrade approach available as back-up, if necessary. In two patients the ureteral orifice could not be visualized cystoscopically, thus precluding the retrograde approach. In the eight remaining patients, the retrograde approach alone never allowed successful stenting. In six patients, combined antegrade and retrograde approaches permitted stent insertions. In three of those six patients, a complex catheterization procedure was necessary. In two patients the combined approach failed altogether. Therefore, 6 of 10 patients underwent a successful stenting procedure with the combined approach; all ultimately closed the fistula. Antegrade stent insertion remains the treatment of choice for ureteral leaks. If the antegrade approach fails, the retrograde approach alone is not likely to be successful. Instead, a combination of both approaches often does succeed.

Percutaneous antegrade ureteric stent insertion in malignant disease.

Untreated, progressive bilateral ureteric obstruction, or unilateral ureteric obstruction in patients with a solitary functioning kidney, will ultimately lead to uraemia, renal failure and death. This paper describes 34 successful percutaneous antegrade ureteric stent placements from 37 attempts, performed on 25 selected patients with a history of malignant disease, in whom retrograde ureteric stenting was impossible or difficult.

Improved localisation of the proximal end of antegrade ureteric stents.

The use of antegrade ureteric stent insertion in patients with ureteric obstruction is well established (Pfister & Newhouse, 1979; Bigongiari, 1981; Mitty et al, 1983). The method used varies, but at Guy's Hospital the current technique involves passing a double-J ureteric stent over a Coon's guidewire. Placement is facilitated by the use of a Lunderquist Owman bile duct dilatation system (12 F sheath, 8 F Teflon dilator). When the stent is inserted as a primary procedure, a “safety” nephrostomy catheter is inserted at the end of the procedure down the track used for the stent.

Percutaneous nephrostomy and antegrade ureteral stent insertion

Sixty consecutive percutaneous nephrostomies were attempted in 37 patients with a 97-per cent success rate. The patients ranged in age from three to seventy-three years. Twenty-eight attempted nephrostomies were bilateral and 32 unilateral. When possible, the percutaneous nephrostomies were converted into internal ureteral stents by antegrade techniques. In each case of apparent complete ureteral obstruction, the area was successfully negotiated, and an indwelling ureteral stent was placed. In 2 patients, combined antegrade and retrograde techniques were required for successful internal stent placement. There was one failure because of a subcapsular hematoma resulting from multiple punctures with an l8-gauge needle. One major complication occurred when a segmental branch of the renal artery was injured by the nephrostomy catheter.