Retrograde Ureteral Stent Research Articles

MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP15)1 Apr 2020MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE Ricardo Matos Rodrigues*, Bárbara Silva, Nuno Morais, José Pedro Pereira, Sara Anacleto, Pedro Passos, Torres João, Emanuel Dias, Estêvão Lima, and Paulo Mota Ricardo Matos Rodrigues*Ricardo Matos Rodrigues* More articles by this author , Bárbara SilvaBárbara Silva More articles by this author , Nuno MoraisNuno Morais More articles by this author , José Pedro PereiraJosé Pedro Pereira More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Pedro PassosPedro Passos More articles by this author , Torres JoãoTorres João More articles by this author , Emanuel DiasEmanuel Dias More articles by this author , Estêvão LimaEstêvão Lima More articles by this author , and Paulo MotaPaulo Mota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000840.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral calculi can be associated with urinary drainage blockage requiring urgent treatment, usually with urinary diversion with percutaneous nephrostomy or retrograde ureteral stent, but primary ureteroscopy with stone removal can be an option. Currently no strong evidence exists to support the superiority of one method over the others. This study proposes to compare these three approaches regarding stone management efficacy, complication rate and its effect on patient's quality of life (QoL). METHODS: A prospective trial was carried out and 94 patients were selected with hydronephrosis secondary to ureteral stones requiring urgent urinary treatment. The patients were divided into three groups according to treatment technique: percutaneous nephrostomy (PCN), retrograde ureteral stent (RUS) or primary ureteroscopy with stone removal (pURS). The stone management efficacy, complications and QoL were evaluated (EQ VAS). RESULTS: A PCN group (n=21), a RUS group (n=53) and a pURS group (n=20) were set. Stone size was higher in RUS (median=9mm) than PCN (median=8mm) and pURS (median=7mm). All pURS successfully removed the stone and the spontaneous stone passage (SSP) after multivariable analysis was higher for PCN than RUS (OR=2,31). A decrease between pre- and post-intervention QoL was found with RUS (p<.001), but not found with PCN (p = .092) and an increase was found with pURS (p=.011). Patients in pURS group experienced less haematuria (p<.001), dysuria (p<.001), urgency (p<.001) (table 1.1), and less need of antibiotics use (p=.005), than RUS and PCN (table 1.2). CONCLUSIONS: pURS shows better chance of higher stone management efficacy than PCN and RUS, moreover PCN was associated with higher rate of spontaneous stone passage than RUS. The QoL improve for pURS patients and decrease for RUS patients. pURS was associated with less symptoms and complications than PCN and RUS, regarding RUS had the higher level of patients with symptoms and complication rate. The pURS appears to be a safe and optimal solution for treatment of patients with ureteral calculi with urinary drainage blockage requiring active treatment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e205-e206 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Matos Rodrigues* More articles by this author Bárbara Silva More articles by this author Nuno Morais More articles by this author José Pedro Pereira More articles by this author Sara Anacleto More articles by this author Pedro Passos More articles by this author Torres João More articles by this author Emanuel Dias More articles by this author Estêvão Lima More articles by this author Paulo Mota More articles by this author Expand All Advertisement PDF downloadLoading ...

Radiological retrograde ureteric stent exchange in women: a single-centre review

To evaluate the safety and efficacy of modified wire loop technique for retrograde stent exchange. All patients were from the KK Women and Children's Hospital where there is no on-site urology service. Patients were identified retrospectively from the institutional radiological information system (RIS) database. In total, 270 stents were removed and 238 replaced for 79 patients between January 2012 to December 2016. Success rates for stent removal and exchange as well as skin dose and fluoroscopy time were assessed. Stent exchange was successful in 234/238 (98%) of cases. Failure was due to loss of access (one case), inability to snare stent due to distorted anatomy (two cases), and extensive encrustation of stent (one case). In 252/270 (93%) cases, stent was removed using modified snare while in 18 (7%) cases, other snare devices were used. Average fluoroscopy time per stent for stent exchange was 573 seconds and average skin dose was 12,494 DAP/mGy•cm2. Fluoroscopy-guided retrograde ureteric stent exchange using the modified snare loop technique is effective, quick, and can be performed easily with equipment used in daily intervention practice. It may also be coupled with ureteroplasty, which may help the patient achieve eventual stent-free status.

Measures Undertaken for the Management of Obstructive Uropathy in Advanced Carcinoma Cervix

Objectives: To find out the procedures adopted for the management of obstructive Uropathy in advanced Carcinoma cervix and To identify the most excellent option for their management. Methods: It was a retrospective cross sectional study. Data were collected from patient’s record of Urology outpatient department (OPD) and indoor of Dhaka Medical College Hospital (DMCH) for the year 2010. Patients attended with other causes of obstructive uropathy were excluded. Results: Total 32 patients were included in this study. Mean age of the patients was 46±6.90 years. All of them were squamous cell carcinoma of stage III &amp; IV disease. About 60% patients received pre-operative radiotherapy for cervical cancer. Twenty three patients underwent retrograde ureteral stenting, 6 patients underwent percutaneous nephrostomy (PCN) and rest 3 underwent cutaneous ureterostomy. Mean pre-operative serum creatinin was 2.68±.24 mg/dl. and post-operatively it dropped to 1.30±.05 mg/dl. which is statistically very much significant. Post-operative hydronephrosis also improved significantly following operations. Difference observed in the improvement of renal function or hydronephrosis among the surgical procedures but it was not statistically significant. Conclusion: Any of the surgical procedures undertaken for the management of obstructive uropathy due to advanced carcinoma of cervix, provided significant improvement of renal function and hydronephrosis. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.15-17

Minimally invasive management of acute ureteral obstruction and severe infection caused by upper urinary tract calculi.

PURPOSETo evaluate therapeutic efficacy of two minimally invasive surgical methods in managing acute ureteral obstruction and severe infection caused by upper urinary tract calculi (UUTC).PATIENTS AND METHODSData of 47 patients diagnosed with acute upper urinary tract obstruction and severe infection caused by ureteral calculus using X-ray CT between September 2014 and January 2019 were retrospectively analyzed. All patients were treated with immediate renal drainage and, after infection and ureteral obstruction were relieved, UUTC removal. Renal drainage was performed by ultrasound-guided percutaneous nephrostomy and retrograde ureteral catheterization was performed using cystoscopy. Kidney and ureteral stones were removed; renal function and the urinary tract were examined by X-ray during follow-up.RESULTSPercutaneous nephrostomy was performed in 29 patients in a critical condition including intolerance to surgery, high-grade hydronephrosis, or failure of retrograde ureteric stent placement. In other 18 patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis, indwelling double-J ureteral stents were temporally installed by a cystoscope. Acute infection and ureteral obstruction were relieved; white blood cell counts returned to normal values within 3 to 7 days after drainage in all patients. In the second-stage treatment, percutaneous nephrolithotomy (PCNL), ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and nephrectomy were performed in 24, 10, 8 and 5 patients, respectively. No patients developed severe complication after stone removal surgery. All patients were followed up for 3 months to 4.5 years. Renal function was significantly recovered; 17/29 (59%) patients with elevated serum creatinine returned to normal and serum creatinine in 12/29 (41%) patients improved significantly after drainage, with a pre-operation level of 285±169μM vs 203±91μM post-operation (P = 0.014). Five patients were lost during follow-up.CONCLUSIONThis study demonstrated an optimal approach for relieving upper urinary tract obstruction and acute infection in which percutaneous nephrostomy drainage is preferred for patients with severe pyonephrosis, large stones (>10 mm) with high-grade hydronephrosis, steinstrasse, or failure in retrograde ureteric stent placement, while retrograde ureteral catheterization using cystoscopy is suitable for patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis.

Placement of double-J stent in patients with malignant ureteral obstruction: antegrade or retrograde approach?

To determine whether antegrade or retrograde methods should be preferred for double-J stent placement in patients with malignant ureteral obstruction (MUO). The medical records of patients treated for MUO in the Urology and Interventional Radiology Clinic, Konya Training and Research Hospital, were reviewed retrospectively. Patients with benign aetiology were excluded from the study. Reports of the procedures, ultrasonography findings, computed tomography (CT), angiography, and pyelography images and the follow-up records of patients with MUO were assessed. A total of 111 patients and 114 ureteral stenting treatments were included in the study; 63 (55.3%) were operated on using the antegrade ureteral stenting (AUS) method, whereas 51 (44.7%) were operated on using the retrograde ureteral stenting (RUS), method, and the characteristics of these groups were evaluated. The presence of hydroureteronephrosis and ureteral tortuosity were determined. Overall success rates were found to be 95.2% using the AUS method and 47.1% using the RUS method. The technical success of the antegrade method was significantly higher in patients with or without tortuosity (respectively: p=0.005, Z shape p=0.001, pigtail shape p=0.035″). The technical success of the antegrade method was significantly higher in patients with hydroureteronephrosis (p=0.001). The AUS technique should be the first choice for double-J stent placement in patients with MUO.

Clinical application of fluoroscopic guided percutaneous antegrade ureteral stents placement for the treatment of malignant ureteral obstruction.

To investigate the clinical efficacy and safety of fluoroscopic guided percutaneous antegrade ureteral stents placement used for treatment of malignant ureteral obstruction. Between April 2016 and March 2018, fluoroscopic guided percutaneous ureteral stents was performed in 25 patients, including 7 patients (28%) with bilateral obstruction. The most common cancer diagnoses were cervical cancer (28%), rectal cancer (24%) and colon cancer (16%) among these patients. Clinical data were retrospectively analyzed with respect to the efficacy, safety and outcome of this treatment method. Percutaneous antegrade placement of ureteral stents was performed in all cases, including 12 ureters that failed in the initial retrograde ureteral stents placement. The median stent patency time for the antegrade ureteral stents were 10.4 (95% CI: 8.3-12.6) months. The primary complications included mild flank pain and discomfort (44%), hematuria (44%), urinary tract infection (8%), bladder irritation symptoms (4%), and arterial bleeding (4%). Fluoroscopic guided percutaneous ureteral stents placement is a safe, efficient procedure and has a high success rate in patients with malignant ureteral obstruction.

Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Cervical cancer is the 3rd most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P&lt;0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.

144 - Percutaneous nephrostomy vs ureteral stent for hydronephrosis secondary to ureteric calculi: Impact on spontaneous stone passage and health-related quality of life – a prospective study

INTRODUCTION AND OBJECTIVES:Ureteral calculi can be associated with urinary drainage blockage, requiring urinary diversion with percutaneous nephrostomy (PCN) or retrograde ureteral stent (RUS). Cu...

Intraoperative Evaluation of Urinary Tract Injuries at the Time of Pelvic Surgery: A Systematic Review.

The aim of this study was to determine the safety and efficacy of methods for intraoperative evaluation of urinary tract injury during pelvic surgery. PubMed, EMBASE, CINAHL, Web of Science, Scopus, ProQuest, the Cochrane Library, and Clinicaltrials.gov were searched from 1947 to February 2018. Articles or abstracts describing the routine evaluation of urinary tract injuries during pelvic surgery in adults were included, surgical indications of urinary tract anomaly, stones, or malignancy were excluded. There were no restrictions on study design or language. Outcomes included injuries diagnosed intraoperatively, delayed diagnoses, adverse effects, subjective assessments, time to use, and cost. Data were extracted in duplicate at an individual-participant level. Prevalence of injuries, sensitivity, specificity, and predictive values of each diagnostic method were calculated. A combination of generalized linear models and a Bayesian approach were used to separately pool diagnostic accuracy measures. There were 5303 titles, 527 abstracts, and 164 full-text articles assessed for eligibility; 69 articles were analyzed. Diagnostic methods retrieved were cystoscopy using saline, dextrose or unspecified distention media, oral phenazopyridine and vitamin B, intravenous (IV) methylene blue, IV sodium fluorescein, IV indigo carmine, prophylactic retrograde ureteral stents, and transabdominal Doppler ultrasound. Prevalence of urinary tract injury ranged from 0.3% to 2.8%. Sensitivity ranged 63% to 91%, and specificity, 99.7% to 100%, with no significant differences suggested between methods. All evaluable methods of intraoperative urinary tract assessment during pelvic surgery are safe and effective with specificity of greater than 99% and low rates of complications. Larger, more rigorous studies are required to evaluate the diagnostic accuracy of some newer methods.

Minimally invasive surgical treatment on delayed uretero-vaginal fistula

ObjectiveTo evaluate the procedure of endoscopic surgery for ureterovaginal fistula (UVF) and its clinical efficacy.Materials and methodsA retrospective analysis of 46 patients needing treatment for UVF with endourology technology was conducted (all patients had unilateral ureteric injury, 27 left and 19 right). Transurethral retrograde ureteric stenting or realignment retrograde/antegrade approach stenting was used to treat the fistula, and the relation between treatment and prognosis was analyzed.ResultsOne case failed, the patient undergoing percutaneous nephrostomy instead. Success was achieved in 45 cases, and urinary leakage was stopped 48 h after surgery. Of the 45 patients operated on, 16 had their double-J stents removed after 3–6 months, and 29 needed replacement every 6–12 months. In a postoperative follow-up of 6–36 months, 10 patients had recurrent stenosis needing ureteroscopic endoureterotomy or reexpansion with a balloon. No other complications occurred.ConclusionsEndoscopic surgery is an effective technology in the treatment of UVF, with the advantages of being effective, reliable, less invasive, and readily accepted by patients.

Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre

BackgroundElective treatment of ureteric stones is needed after emergency drainage of urosepsis. ObjectiveWe wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). Design, setting, and participantsData of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012–December 2016) were prospectively collected. InterventionElective URS following previous emergency RUS or PCN. Outcome measurements and statistical analysisOutcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24. Results and limitationsIn total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2–23) and 10.8 (2–32) mm, respectively. The mean operating time was 42 (5–129) min with stone-free rate (SFR) of 97% (n=74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p=0.001). ConclusionsElective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade. Patient summaryIn this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling.

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.

Gastrointestinal cancer and bilateral hydronephrosis resulted in a high risk of ureteral stent failure

BackgroundUrologists frequently encounter malignant ureteral obstruction (MUO) caused by advanced urological or non-urological malignant disease, but the treatment policy is unclear. The present study examined the risk factors for predicting ureteral stent failure in patients with MUO after ureteral stent insertion and the change in the renal function after retrograde ureteral stent insertion in cases of bilateral hydronephrosis.MethodsA total of 39 patients who required ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, Japan) between February 2007 and May 2016 were included in this study. The age, gender, type of cancer, hydronephrosis side, pre-stenting estimated glomerular filtration rate (eGFR), and eGFR increase were assessed as predictive factors for stent failure. Among these 39 patients, 25 showed bilateral hydronephrosis. Thirteen of these patients had bilateral ureteral stents placed, and the remaining 12 had a unilateral ureteral stent placed. The renal function and overall survival (OS) were analyzed between these two groups.ResultsAmong all 39 patients, 9 (23.1%) had stent failure. A univariate analysis revealed that causative disease (gastrointestinal cancer vs. others; p = 0.045) and laterality of hydronephrosis (bilateral vs. unilateral; p = 0.05) were associated with stent failure. A multivariate analysis revealed that only age (hazard ratio, 0.938; 95% confidence interval, 0.883–0.996; p = 0.038) was associated with stent failure. A Kaplan-Meier analysis and log-rank test indicated that having a unilateral ureteral stent placed was not correlated with a lower OS rate than having bilateral ureteral stents placed (p = 0.563). Among patients with bilateral hydronephrosis, the increase in the eGFR of those who had bilateral ureteral stents placed was not significantly different from that of those who had a unilateral ureteral stent placed (p = 0.152).ConclusionsWe revealed that age > 60 years was helpful for predicting stent failure. MUO due to gastrointestinal cancer and bilateral hydronephrosis may be predictive of stent failure. These factors may help urologists decide the optimal time to perform early percutaneous nephrostomy. These findings suggest that patients with bilateral hydronephrosis do not necessarily need to have a ureteral stent placed into both sides of the hydronephrosis.

3:27 PM Abstract No. 64 Radiological retrograde ureteric stent exchange: a large single-center review

3:27 PM Abstract No. 64 Radiological retrograde ureteric stent exchange: a large single-center review

Renal function is associated with prognosis in stent-change therapy for malignant ureteral obstruction.

PurposeThe authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis.Materials and MethodsBetween January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling.ResultsBefore stenting, 91 patients were CKD stages 1–3 and 26 patients were CKD stages 4–5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1–3 group and 23 in the CKD stages 4–5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors.ConclusionsInternal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.

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.

Retrograde pyelography predicts retrograde ureteral stenting failure and reduces unnecessary stenting trials in patients with advanced non-urological malignant ureteral obstruction.

ObjectiveTo evaluate predictive factors for retrograde ureteral stent failure in patients with non-urological malignant ureteral obstruction.Materials and methodsBetween 2005 and 2014, medical records of 284 malignant ureteral obstruction patients with 712 retrograde ureteral stent trials including 63 (22.2%) having bilateral malignant ureteral obstruction were retrospectively reviewed. Retrograde ureteral stent failure was defined as the inability to place ureteral stents by cystoscopy, recurrent stent obstruction within one month, or non-relief of azotemia within one week from the prior retrograde ureteral stent. The clinicopathological parameters and first retrograde pyelographic findings were analyzed to investigate the predictive factors for retrograde ureteral stent failure and conversion to percutaneous nephrostomy in multivariate analysis with a statistical significance of p < 0.05.ResultsRetrograde ureteral stent failure was detected in 14.1% of patients. The mean number of retrograde ureteral stent placements and indwelling duration of the ureteral stents were 2.5 ± 2.6 times and 8.6 ± 4.0 months, respectively. Multivariate analyses identified several specific RGP findings as significant predictive factors for retrograde ureteral stent failure (p < 0.05). The significant retrograde pyelographic findings included grade 4 hydronephrosis (hazard ratio 4.10, 95% confidence interval 1.39–12.09), irreversible ureteral kinking (hazard ratio 2.72, confidence interval 1.03–7.18), presence of bladder invasion (hazard ratio 4.78, confidence interval 1.81–12.63), and multiple lesions of ureteral stricture (hazard ratio 3.46, confidence interval 1.35–8.83) (p < 0.05).ConclusionRetrograde pyelography might prevent unnecessary and ineffective retrograde ureteral stent trials in patients with advanced non-urological malignant ureteral obstruction.

Antegrade Ureteral Stenting is a Good Alternative for the Retrograde Approach

Background/Aims: Double J (JJ) stents for treating obstructive ureteral pathology are generally inserted through a retrograde route with cystoscopic guidance. Antegrade percutaneous insertion using fluoroscopy can be performed alternatively but is less known. Indications, success rate and complications of antegrade ureteral stenting were evaluated. Methods: Data of consecutive patients in which antegrade ureteral stenting was performed were retrospectively analysed using the radiology information system and patient records. Patient characteristics, details of the antegrade JJ stent insertion procedure and registered complications were collected. Furthermore, it was investigated if prior to the antegrade procedure a retrograde attempt for JJ stent insertion was performed. Results: Total 130 attempts for antegrade JJ stent insertion were performed in 100 patients. A percutaneous nephrostomy catheter had already been placed in the majority of kidneys (n = 109) for initial treatment of hydronephrosis. Most prevelant indication for a JJ stent was obstructive ureteral pathology due to malignancy (n = 63). A JJ stent was successfully inserted in 125 of 130 procedures. In 21 cases, previous retrograde ureteral stenting had failed but, subsequent antegrade ureteral stenting was successful. There were 8 procedure related complications; 6 infections, 1 false tract and 1 malposition. Conclusion: Antegrade percutaneous insertion of a JJ stent is a good alternative for retrograde insertion.

Bilateral obstructive uropathy following laparoscopic appendicectomy

A fifty four year old man presented with renal failure several days following laparoscopic appendicectomy. Imaging revealed a large rectus sheath haematoma extending into the pelvis causing bilateral ureteric obstruction. The initial reason for renal failure was not clear as imaging did not reveal significant hydronephrosis as would usually be expected with ureteric obstruction, however renal function failed to improve despite addressing pre-renal causes of renal impairment. He was treated with both a retrograde ureteric stent and percutaneous nephrostomy.

Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome.

Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.