Retrograde Ureteral Stent Placement Research Articles

Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women

PurposeTo evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. Materials and MethodsEighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. ResultsA total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19–85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). ConclusionsImaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.

A misplacement of a ureteral stent into the abdominal aorta: a case report of a rare retrograde ureteral stenting complication

BackgroundCervical cancer is often associated with malignant ureteral obstruction and consequent hydronephrosis. Hydronephrosis caused in this way can be resolved by placing ureteral stents or performing a percutaneous nephrostomy. Complications that may occur during the retrograde ureteral stent placement are usually mild, but serious complications such as stent migration into the cardiovascular system are also possible. Here we present an unusual case where a ureteral stent entered the abdominal aorta during the cystoscopic ureteral stenting, which was resolved by a cystoscopic stent removal kept in check by endovascular catheters.Case presentationsThe 48-year-old female patient was treated in the regional secondary healthcare facility due to bilateral hydronephrosis caused by cervical cancer. The patient had bilateral percutaneous nephrostomies and ureteral stents. Due to the calcification of the left ureteral stent, an urethrorenoscopy with lithotripsy of the calculus in the left ureter was performed in the regional secondary healthcare facility, and the ureteral stent was cystoscopically replaced. The control radiography of the urinary tract showed a misplacement of the left ureteral stent, and a computed tomography showed that the stent was located in the abdominal aorta. The patient was referred to the University Clinical Center of Serbia, where a ureteral stent was cystoscopically removed from the abdominal aorta under the control of endovascular catheters. The patient was in good general condition at all times, with no signs of bleeding, and she was discharged from the hospital on the fourth postoperative day.ConclusionsThe migration of a ureteral stent into the abdominal aorta and the cardiovascular system in general is a rare type of ureteral stenting complication whose treatment requires a multidisciplinary approach. In order to prevent such complications, it is necessary to strictly adhere to the indications for the ureteral stent placement in the case of malignant ureteral obstruction. Also, this procedure should be performed according to the current guidelines and controlled by an X-ray or ultrasound.

Comparison between Antegrade versus Retrograde Ureteral Stent Placement for Malignant Ureteral Obstruction

PurposeTo compare the technical success of antegrade uteral stent (AUS) and retrograde ureteral stent (RUS) placements in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS. Materials and MethodsThis study retrospectively included 61 AUS placements (44 patients) performed under fluoroscopic guidance and 76 RUS placements (55 patients) performed under cystoscopic guidance in patients with MUO from January 2019 to December 2020. Technical success rates of the 2 techniques were compared using inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures. ResultsTechnical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4%; 95% confidence interval [CI], 35.4%–63.1%). The independent predictors for technical failure of the RUS procedure were age of ≥65 years (odds ratio [OR], 5.56; 95% CI, 1.73–21.27), ureteral orifice invasion (OR, 4.21; 95% CI, 1.46–13.46), and extrinsic cancer (OR, 15.58; 95% CI, 2.92–111.81). ConclusionsThe technical success rate of AUS placement was higher than that of RUS placement in patients with MUO. RUS failure was associated with age of ≥65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.

MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY Wesley Yip, Daniel Sjoberg, Nathan Wong, Manuel de Jesus Escano, Song Jiang, Carissa Chu, Nicole Benfante, Sherri Donat, Harry Herr, Guido Dalbagni, Bernard Bochner, and Eugene Cha Wesley YipWesley Yip More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Nathan WongNathan Wong More articles by this author , Manuel de Jesus EscanoManuel de Jesus Escano More articles by this author , Song JiangSong Jiang More articles by this author , Carissa ChuCarissa Chu More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Sherri DonatSherri Donat More articles by this author , Harry HerrHarry Herr More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Bernard BochnerBernard Bochner More articles by this author , and Eugene ChaEugene Cha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral obstruction by bladder tumors can cause hydronephrosis with the potential for renal dysfunction. Renal drainage can be achieved by either ureteral stent placement or percutaneous nephrostomy tube, but there is a potential risk for upper tract seeding by retrograde manipulation during stent placement and reflux of urine. We aim to determine if retrograde ureteral stent placement prior to radical cystectomy (RC) increases the risk of upper tract recurrence. METHODS: 2475 patients who underwent RC at our institution from January 2000 to June 2016 were included in our analysis. Patients were categorized by: no drainage, nephrostomy tube only, or stent with or without nephrostomy tube. Fine-Gray competing risks regression analysis was used to assess whether ureteral stent placement increased the risk of upper tract recurrence, with recurrence to another region and death from other causes as the competing events. Univariable and multivariable models were then created, with the latter adjusted for pathologic T stage, carcinoma in situ (CIS) in the RC specimen, and prior intravesical therapy. RESULTS: Of 2475 patients who underwent RC, 111 upper tract recurrences were observed with a median follow-up of 6.0 years (IQR 2.5, 9.3) among those without an event. 2203 (89%) patients had no drainage, 88 (3.6%) had a nephrostomy tube only, and 184 (7.4%) had a ureteral stent with or without nephrostomy tube. There were 98 upper tract recurrences in the no drainage group, only 1 in the nephrostomy tube group, and 12 in the ureteral stent group. The probability of upper tract recurrence based on drainage method is displayed in Figure 1. On multivariable analysis, ureteral stent placement was associated with an increased risk of upper tract recurrence (HR 2.32; 95% CI 1.27, 4.22). CONCLUSIONS: Ureteral stent placement for ureteral obstruction prior to radical cystectomy is associated with an increased risk of upper tract recurrence compared to nephrostomy tube placement, although patient selection factors not accounted for in our analyses may be present. This should be considered when weighing the risks and benefits of ureteral stent versus nephrostomy tube placement in these patients. Source of Funding: Ruth L. Kirschstein National Research Service Award T32CA082088 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e977 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Yip More articles by this author Daniel Sjoberg More articles by this author Nathan Wong More articles by this author Manuel de Jesus Escano More articles by this author Song Jiang More articles by this author Carissa Chu More articles by this author Nicole Benfante More articles by this author Sherri Donat More articles by this author Harry Herr More articles by this author Guido Dalbagni More articles by this author Bernard Bochner More articles by this author Eugene Cha More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of radiation on the incidence and management of ureteroenteric strictures: a contemporary single center analysis

BackgroundUreteroenteric stricture incidence has been reported as high as 20% after urinary diversion. Many patients have undergone prior radiotherapy for prostate, urothelial, colorectal, or gynecologic malignancy. We sought to evaluate the differences between ureteroenteric stricture occurrence between patients who had radiation prior to urinary diversion and those who did not.MethodsAn IRB-approved cystectomy database was utilized to identify ureteroenteric strictures among 215 patients who underwent urinary diversion at a single academic center between 2016 and 2020. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Strictures due to malignant ureteral recurrence were excluded (3 patients). Statistical analysis was performed using chi squared test, t-test, and Wilcoxon Rank-Sum Test, logistic regression, and Kaplan–Meier analysis of stricture by cancer type.Results65 patients had radiation prior to urinary diversion; 150 patients did not have a history of radiation therapy. Benign ureteroenteric stricture rate was 5.3% (8/150) in the non-radiated cohort and 23% (15/65) in the radiated cohort (p = < 0.001). Initial management of stricture was percutaneous nephrostomy (PCN) in 78% (18/23) and the remaining 22% (5/23) were managed with primary retrograde ureteral stent placement. Long term management included ureteral reimplantation in 30.4% (7/23).ConclusionsOur study demonstrates a significant increase in rate of ureteroenteric strictures in radiated patients as compared to non-radiated patients. The insult of radiation on the ureteral microvascular supply is likely implicated in the cause of these strictures. Further study is needed to optimize surgical approach such as utilization of fluorescence angiography for open and robotic approaches.

Retrograde ureteric stent insertion from percutaneous suprapubic access to the bladder in renal transplant recipients with ureteric stenosis: a novel minimally invasive technique

BackgroundUreteric stricture is a common and salvaging complications after renal transplantation. Two treatment methods are usually used, retrograde ureteral stent placement and percutaneous nephrostomy. The former has a higher failure rate, the latter has a great risk. Therefore, a safe and reliable treatment is needed.Case presentationA technique of retrograde insertion of ureteral stent was established, which was applicable in three transplant recipients with post-transplant ureteral stenosis, and the data was retrospectively recorded. The patients are 2 men and 1 woman, ages 44, 27 and 32 years. These patients underwent a total of five times of retrograde insertion of ureteral stent between 2018 and 2019. None of these patients had any postoperative complication, but all patients had complete recovery from oliguric status within two weeks.ConclusionsThe retrograde ureteric stent insertion by percutaneous suprapubic access to the bladder (RUS-PSAB) was demonstrated feasibility and safety in a case series with short-term follow-up. However, larger prospective studies are needed.

Minimally Invasive Approach to Ureteral Stricture in Transplant Kidney by Periodic Retrograde Ureteral Stent Placement and Exchange

PurposeThe aim of the study was to evaluate the effectiveness of minimally invasive treatment of ureteral strictures and describe the technique that we used for retrograde placement of ureteral stent in transplant kidneys. Material and methodsWe reviewed the medical cards of all transplant kidney patients with persistent ureteral strictures who were managed with periodical ureteral stent placement and balloon dilatation between 2008 and 2016. Different maneuvers that were used to overcome the difficulties for retrograde ureteral stent placement and exchange were discussed. Clinical characteristics and treatment outcomes of the study cohort were analyzed. ResultsBetween 2008 and 2016, a total of 1026 transplantations were performed in our clinic, and ureteral stricture was found in 13 patients (1.26%). Of the 13 patients, 8 were treated with periodic ureteral stent insertion and balloon dilatation. Ureteral stent insertion or stent exchange was performed in 52 transplant renal units. The overall success rate of retrograde ureteral stent insertion at the first attempt was 75% and stent exchange success rate was 100%. Renal function remained stable in all patients during a median follow-up of 41 months (range, 13–60 months). No other local or systemic complication was encountered and no stent encrustation was noted. ConclusionsEndoscopic management of ureteral stricture by periodical retrograde ureteral stent replacement and balloon dilatation is safe, effective, and highly successful in transplant patients who are not eligible for open reconstructive surgery.

Transplant Kidney Retrograde Ureteral Stent Placement and Exchange: Overcoming the Challenge

To present a reliable technique for fluoroscopic controlled, large-bore, ureteral stent placement and exchange in transplant kidneys with persistent ureterovesical strictures. We reviewed the medical charts of all patients who underwent kidney transplant with persistent ureterovesical strictures who underwent ureteral stent placement or exchange at our institution between 2005 and 2015 using the new technique. Clinical characteristics and treatment outcomes of the study cohort were analyzed. Ureteral stent insertion or stent exchange, using this technique, was performed in 32 renal transplant units. Median operating time was 24 minutes (interquartile range, 21-36.75 minutes). The overall success rate of the technique at first attempt was 96.9%. In 1 patient, drainage of the transplanted kidney with a nephrostomy tube was indicated after procedure failure. No other local or systemic complications were encountered, and no stent encrustation was noted in this cohort of patients. Renal function remained stable in all patients during a median follow-up of 59 months (interquartile range, 28-61 months). Herein, we present in detail a step-by-step technique for the insertion and exchange of large-bore ureteral stents in transplanted kidneys. The technique was shown to be safe, effective, and highly successful.

Sp615 EUS-Guided Anterograde Ureteral Internal Drainage

Retrograde ureteral stent placement by cystoscopy is the standard in patients with malignant ureteral obstruction due to advanced bladder cancer. When this attempt fails, the most common procedure used is percutaneous nephrostomy. EUS-Guided Anterograde Ureteral Internal Drainage is an alternative and it has been described before. We report a case of a 62-year old man that presented with flank pain and hematuria. After clinical and imaging evaluation, he was diagnosed with locally advanced bladder cancer. At the time of diagnosis, he presented bilateral hydronephrosis and renal failure. He was submitted to a retrograde approach by cystoscopy that succeeded in stent placement at right side ureteral obstruction, but failed at left side ureteral stent placement. In this presentation, we will demonstrate a EUS-Guided Anterograde Ureteral Internal Drainage in a patient with failure at retrograde approach by cystoscopy. By a single-step procedure, the EUS linear equipment was positioned at gastric greater curvature and it was possible to observe the dilated proximal ureter. Doppler analysis was obtained to confirm the fact that it had not any vessels nearby the working area. After that, it was performed a proximal ureteral puncture using a 19-Gauge needle. Contrast media was injected in proximal ureter and an urethrography was obtained. A 0.035-inch guidewire was passed in the left ureter. By progression of the guidewire, its distal part passed through the obstructed area and was positioned inside the bladder. Over the guidewire and under radioscopic view, an 8.5 Fr double-pigtail hydrophilic-coated stent was placed. The stent was positioned with the proximal part inside the ureter and the distal part inside the bladder. EUS-Guided Anterograde Ureteral Internal Drainage was a feasible technique and the patient presented with improvement in renal function. EUS-Guided Anterograde Ureteral Internal Drainage is an alternative to the Percutaneous Nephrostomy, which can be considered for palliation of ureteral obstruction patients with advanced bladder cancer. Larger multicenter studies are needed to further assess this novel technique.

244 An Interim Analysis Comparing EUS-Guided Anterograde Ureteral Internal Drainage Versus Percutaneous Nephrostomy in Patients With Advanced Bladder Cancer and Renal Failure: A Prospective and Randomized Trial

Retrograde ureteral stent placement by cystoscopy is the standard in patients with malignant ureteric obstruction due to advanced bladder cancer. When this fails alternative is percutaneous nephrostomy. EUS-guided transgastric internal double pigtail stent placement is an alternative and has been described.

Current Outcome of Patients With Ureteral Stents for the Management of Malignant Ureteral Obstruction

We analyzed the prognostic factors associated with overall survival and predictive factors of stent failure in patients treated with an indwelling retrograde ureteral stent for malignant ureteral obstruction. Among 186 Japanese patients treated with an indwelling retrograde ureteral stent for ureteral obstruction from January 2005 to March 2010, 61 with malignant ureteral obstruction and 95 ureteral units were analyzed retrospectively. Median survival was estimated at 228 days. Unfavorable prognostic factors of overall survival were no treatment after indwelling retrograde ureteral stent placement (p = 0.023) and a serum creatinine before indwelling retrograde ureteral stent placement of 1.2 mg/dl or greater (p = 0.016). Overall survival differed significantly among cancer groups (p <0.001) as did stent failure-free survival (p = 0.011). Overall survival differed significantly among 3 risk groups divided according to the score calculated with regard to prognostic factors (p <0.001). Gynecologic cancer was a significant favorable predictor of stent failure-free survival. Patients treated with an indwelling retrograde ureteral stent for malignant ureteral obstruction were divided into 3 groups, which showed significant differences in overall survival. This risk classification may help urologists predict survival time.

Management of Urine Leak After Laparoscopic Cyst Decortication with Retrograde Endoscopic Fibrin Glue Application and Ureteral Stent Placement

Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.

Retroperitoneoscopic Living Donor Nephrectomy: Experience of 425 Cases at a Single Center

Laparoscopic living donor nephrectomy (LLDN) is a standard method of donor nephrectomy. Most cases of LLDN are transperitoneal. Retroperitoneal access, however, implies a direct approach to the retroperitoneal organs without interfering with any of them. Since 2001, we have been trying to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN). To assess the safety, feasibility, and usefulness of RPLDN, we reviewed the experience with this technique at our institution. From July 2001 to March 2009, 425 patients underwent live donor renal transplantation at our institution with allografts procured by RPLDN. Study variables included operative time, time to retrieval of the kidney, blood loss, warm ischemia time, length of hospital stay, number and length of renal vessels, graft function, and complications. Mean follow-up was 53 months. Donor nephrectomy was performed successfully in all patients. The complication rate was 4.9%. In one case, the procedure was changed to open donor nephrectomy because of severe adhesion in the renal hilum from previous surgery. Ureteral complications occurred in four patients, who were successfully treated with retrograde ureteral stent placement. None of the donors needed readmission. Mean warm ischemia time was 4.8 minutes. Creatinine levels returned to normal in all patients, and long-term allograft function was good. Serum creatinine levels at postoperative days 1, 7, and 14 were 3.7 mg/dL, 1.4 mg/dL, and 1.4 mg/dL on average, respectively. Slow graft function was noted in four (1.1%) cases but returned to the normal level within 2 weeks after surgery. One-year donor survival was 99%, and 1-year graft survival was 98.2%. Excellent donor safety and allograft function were obtained with RPLDN. These results suggest that RPLDN could be an option for LLDN.

Intraoperative Retrograde Ureteral Stent Placement and Manipulation During Laparoscopic Pyeloplasty Without Need for Patient Repositioning

Ureteral stent placement during adult laparoscopic pyeloplasty for ureteropelvic junction obstruction can be performed preoperatively or intraoperatively either in a retrograde or antegrade approach. Intraoperative retrograde stent placement is the most commonly used technique. Comparative studies, however, suggest that there is a significant component added to the overall operative times because of the need for patient repositioning from the lithotomy to the flank position before pyeloplasty. During our laparoscopic pyeloplasty surgery, we position the patient in the lateral decubitus position and incorporate a lower extremity support device for female patients. This allows initial open-ended catheter placement and subsequent access to the perineum and final stent placement throughout the procedure without need for patient repositioning. In addition, our technique allows for intraoperative fluoroscopy to delineate the complete ureteral anatomy. Since 2004, we have used this approach in 111 consecutive patients without complications. We describe our technique for intraoperative ureteral stent placement in the flank position during adult laparoscopic pyeloplasty without need for patient repositioning.

Serum Creatinine Predicts Success in Retrograde Ureteral Stent Placement in Patients with Pelvic Malignancies

To evaluate serum hemoglobin, baseline serum creatinine, serum creatinine at the diagnosis of obstructive hydronephrosis, and the increase in serum creatinine greater than baseline to predict for success in retrograde ureteral stent placement in patients with pelvic malignancies. In a retrospective chart review, we identified 57 patients at our institution with obstructive hydronephrosis secondary to pelvic malignancies in which retrograde ureteral stent placement was attempted from January 2002 to May 2005. The patient charts were reviewed for the baseline serum creatinine, preoperative serum creatinine and hemoglobin, and serum creatinine at presentation of obstructive hydronephrosis. This population was divided into group 1 (n = 31, 54%), in which retrograde stent placement was successful, and group 2 (n = 26, 46%), in which stent placement failed and subsequent percutaneous nephrostomy tube placement was required. The Student t test was used to determine whether a significant difference existed between the two groups for each laboratory parameter. The serum hemoglobin and baseline creatinine were not significantly different between the two groups and could not be used to predict for the success or failure of stent placement (P = 0.10 and P = 0.59, respectively). However, the average serum creatinine at presentation of obstructive hydronephrosis was significantly different between group 1 (2.4 +/- 1.4 ng/dL) and group 2 (5.3 +/- 6.3; P = 0.014), as was an increase in serum creatinine greater than baseline (P = 0.002). The results of this study have shown that the serum creatinine level at the presentation of obstructive hydronephrosis can be used to predict for success in retrograde ureteral stent placement in patients with pelvic malignancies.

Success of Ureteral Stents for Intrinsic Ureteral Obstruction

Previous reports suggest a high success rate for retrograde ureteral stenting for intrinsic ureteral obstruction, but few preoperative predictors of success have been offered. We reviewed our experience to look for factors that suggest failure of stents for intrinsic ureteral obstruction. We retrospectively reviewed the outcome of retrograde ureteral stent placement for intrinsic ureteral obstruction without concurrent or intended definitive management of the obstruction. Thirty-eight patients treated for intrinsic ureteral obstruction, representing 41 ureteral units (UUs), were monitored for an average of 25.5 months. The overall success rate was 88%. Of the successes, 13 UUs had definitive therapy to permanently remove the cause of obstruction, obstruction resolved in 12 UUs after stent placement, and 11 UUs were managed with indwelling stents. Therapy failed in five UUs, with a median time to failure of 1.9 months. Of the UUs in which failure occurred, three failures were caused by misdiagnosis; in the remaining two, the stent did not correct the obstruction. On univariate analysis, male sex (P = 0.006), increased creatinine level as a presenting symptom (P = 0.002), and more severe preoperative hydronephrosis (P = 0.042) were predictive of failure. Adverse events were low, with complications from stenting occurring on only four of 41 UUs. If initial stent placement was possible, intrinsic ureteral obstruction was managed successfully in 88% of patients. Given high success and minimal complications, retrograde placement of ureteral stents can be performed to treat patients with intrinsic ureteral obstruction. Treatment failure is more likely to occur in men and patients with severe hydronephrosis or an elevated creatinine level.

Retrograde Ureteral Stents for Extrinsic Ureteral Obstruction: Nine Years’ Experience at University of Michigan

To review our experience with retrograde ureteral stenting for extrinsic ureteral obstruction because previous reports have suggested only moderate success. We performed a retrospective review of the course of patients who underwent retrograde ureteral stent placement from March 1996 to April 2005. The gathered clinical parameters included stent failure, which was defined as any ureteral unit (UU) that remained obstructed. A total of 54 patients treated for extrinsic ureteral compression, representing 87 UUs, were followed for an average of 16 months (range 0.7 to 98) in successful cases. Of the stents, 68% were placed for malignancy, 23% for retroperitoneal fibrosis, and 9% for benign masses. The overall success rate was 84%, with malignancy, retroperitoneal fibrosis, and benign masses having an 81%, an 85%, and a 100% success rate, respectively. Fourteen UUs failed, with a mean time to stent failure of 4.8 months (range 0.07 to 27). Multiple stents were placed in 54 UUs, with a mean of 5.5 stent exchanges, at a mean interval of 3.6 months. On univariate analysis, only greater posttreatment creatinine was associated with stent failure (P <0.01), although stents placed for localized disease tended to be more successful than those placed for regional disease (100% versus 81%, P = 0.07). If initial stent placement was possible, extrinsic ureteral obstruction was managed successfully with retrograde ureteral stent placement in 84% of cases. Because no preoperative characteristics could be identified, except for a trend toward less success in cases of regional disease, retrograde stenting can be considered first-line treatment in patients with extrinsic ureteral obstruction.

85: Serum Creatinine Predicts Success in Retrograde Ureteral Stent Placement in Patients with Pelvic Malignancies

85: Serum Creatinine Predicts Success in Retrograde Ureteral Stent Placement in Patients with Pelvic Malignancies

Retrograde stenting for obstruction of the renal transplant ureter

Objectives To present our experience with retrograde stent placement and stent exchange for transplant ureteral obstruction. Methods A review of our renal transplant database was performed to identify all renal transplant patients who underwent attempted retrograde ureteral stenting for allograft ureteral obstruction or attempted allograft ureteral stent exchange between May 1992 and April 2004. A retrospective review was performed. Results Forty patients underwent 52 attempted retrograde ureteral stent placements, and 11 patients underwent a total of 27 attempted stent exchanges. In patients with ureteral obstruction, the most common clinical signs and symptoms were nausea, vomiting, diarrhea, abdominal pain, fever, decreased urine output, edema, and an elevated serum creatinine. Of the 52 cases of allograft ureteral obstruction and attempted retrograde ureteral stent placement, 28 (53.8%) were managed successfully with retrograde ureteral stenting. Of the 27 attempted stent exchange procedures, a successful exchange was accomplished in 23 cases (85.2%). Conclusions Cystoscopy with retrograde allograft stent placement is a reasonable first approach to the management of transplant ureteral obstruction and is successful in more than one half of cases.

Ureteral stent placement in hydronephrosis during pregnancy

In this study we describe 22 cases of retrograde ureteral stent placement in pregnant women with therapy-resistant flank pain due to hydronephrosis. Eleven were primiparous and one patient expected twins. Eight of 22 patients presented symptoms of pyelonephritis. In 21 cases the hydronephrosis was located on the right and in 4 cases it was bilateral. Maximal lower calix diameter was 12 mm (range 9-22 mm). With the exception of two cases, sonographically controlled stent placement was performed under local anesthesia without sedation. All patients were painfree within 6 days and were given prophylactic low doses of antibiotic until the day of delivery. Renal function remained within the normal limits. Double-J stent displacement occurred in 3 patients - of which one underwent nephrostomy. Postnatal examination demonstrated urolithiasis in 4 of 19 patients. This study provides evidence for effectiveness of retrograde ureteral Double-J stent placement as a therapeutic option in cases of severe symptomatic hydronephrosis during pregnancy with a low morbidity rate.