Upper tracheal stenosis (UTS) is a rare process with multiple causes and variable approaches to treatment. Australian data on management patterns are lacking and patient resources reflecting local practices are scarce. To describe the management strategies of UTS over 12 years among three teaching hospitals in New South Wales, Australia. A secondary aim is to formulate an evidence-based patient information sheet for this condition and its management. Retrospective descriptive case series. Demographic, procedural and spirometric data were obtained from the medical records of patients undergoing bronchoscopy for UTS between March 2012 and February 2024. A total of 31 patients (81% female) underwent 120 procedures (median:3; interquartile range: 1-5) with a median procedure interval of 134 days. The interventions included 82 balloon dilatations, 37 steroid injections, 54 radial incisions (28 endoscopic scissors, 26 laser) and seven stent insertions. Following serial procedures, there were improvements in mean maximum forced expiratory flow (FEFmax) by 1.62 L/s (95% CI: 1.05-2.15, P < 0.001) and FEFmax percent predicted by 27% (95% CI: 18-36, P < 0.001). The mean FEV1 improved by 0.36 L (95% CI: 0.15-0.54, P = 0.002) and 14% predicted. There was a documented improvement in symptoms in 80% of therapeutic procedures. Complications were infrequent and higher in procedures involving stents. Based on these findings, a patient information sheet has been developed. Patients with UTS undergo several bronchoscopies that result in improvements in symptoms and function with relatively low rates of complications.

BACKGROUND Pregnancy following bone marrow transplantation (BMT) and treatment for gastric cancer is rare because of gonadotoxic conditioning regimens, major abdominal surgery, and the overall burden of chronic illness. Reports of spontaneous twin pregnancy after both allogeneic BMT and gastrectomy are exceptionally uncommon. CASE REPORT We describe the case of a 22-year-old woman with a history of severe aplastic anemia treated with allogeneic BMT (February 2022), who subsequently underwent subtotal gastrectomy for gastric adenocarcinoma (May 2022). She conceived spontaneously with a dichorionic-diamniotic twin pregnancy in 2024, several years after completion of oncologic treatment, without fertility preservation. Early pregnancy was uneventful, with reassuring serial ultrasound scans and normal fetal growth. In the second trimester, she developed extensive lower-limb deep vein thrombosis (superficial femoral vein thrombosis confirmed by compression Doppler ultrasound) requiring therapeutic anticoagulation with enoxaparin 1 mg/kg twice daily, followed by obstructive uropathy due to ureteric compression that necessitated double-J stent insertion. Maternal nutritional status and weight gain were closely monitored with serial laboratory assessment (including hemoglobin, ferritin/iron indices, vitamin B12, folate, and albumin) given her prior gastrectomy. Multidisciplinary care involving maternal-fetal medicine, hematology, oncology, urology, and anesthesia teams guided surveillance and delivery planning. At 35+6 weeks of gestation, an elective cesarean section was performed because of dichorionic twin gestation, prior major abdominal surgery, and ongoing therapeutic anticoagulation requiring coordinated perioperative planning. Two live infants with appropriate birthweights and good Apgar scores were delivered, and the postoperative course was uncomplicated for both mother and neonates. CONCLUSIONS This case illustrates that successful twin pregnancy is possible after BMT and gastric cancer surgery when individualized, multidisciplinary care and careful thromboembolic and urological surveillance are provided. It also supports the need for structured preconception counseling, fertility follow-up, and pragmatic monitoring protocols for high-risk pregnancies in young cancer and transplant survivors.

Effect of mirabegron, tamsulosin, and tadalafil on quality of life in patients with indwelling ureteral (double-J) stents.

Outcomes of endoscopic retrograde cholangiopancreatography performed via a lumen-apposing gastroenterostomy stent: a multicenter observational study (with videos).

ObjectivesMalignant upper urinary tract obstruction (MUUTO) is caused by advanced cancer. Developing MUUTO is often associated with approaching the end of life. Percutaneous nephrostomy (PCN) and retrograde ureteric stent insertion (RUS) are common interventions to treat patients with MUUTO, although neither intervention is likely to extend overall survival significantly. Little is known about patient, carer and healthcare professional (HCP) views of the MUUTO management pathway, the benefits and harms of the procedure and the treatment decision-making process. This study investigated the experiences, decision-making and priorities of patients admitted to hospital for MUUTO, and their carers, along with HCPs involved in providing care for this patient group.DesignQualitative, using semi-structured interviews.SettingThis study was conducted across two NHS trusts in England.Participants12 patients, 8 carers and 14 HCPs were interviewed. Patients were interviewed in hospital during their admission and, where possible, follow-up interviews took place 2–3 weeks later at their homes. In total, 18 patient interviews were conducted. Interviews were analysed thematically by cohort and systematically cross-referenced for areas of congruence and divergence of priorities and views. Ethical approval was obtained before study commencement.ResultsMost patients were admitted as emergencies and received PCNs to relieve severe pain and distress. Patients reported having little choice in the decision-making around intervention due to their symptoms and frequently described the PCN procedure as being painful. HCPs considered the availability of further cancer treatment options a rationale to support intervening for MUUTO. However, HCPs reported decision-making was often complicated by unclear prognosis and the need to address the emergency nature of patient circumstances. A lack of compassionate communication, disrespect and indignity, traumatic hospital admission and premature discharge, in addition to practical administrative difficulties caused patient and carer distress.ConclusionsEmergency admissions for MUUTO are associated with significant patient and carer distress and are complex for HCPs to manage. MUUTO patients would benefit from a specific pathway to avoid emergency admissions and to facilitate timely advance care planning discussions so that patients’ wishes and HCP views can be shared and incorporated into decision-making about the appropriateness and value of PCN and RUS interventions.

An underrecognized clinical condition that may afflict high level cyclists is external iliac artery endofibrosis (EIAE). EIAE is an intermittent claudication vascular condition that results from intimal narrowing most often of the external iliac artery (EIA). Symptoms are reported as thigh pain and loss of power that occur during high intensity efforts. EIAE is theorized to be a result of the mechanical and hemodynamic stress within the EIA heightened by psoas muscle hypertrophy in conjunction with the repetitive and extreme hip flexion coupled with high cardiac output. A combination of clinical tests (e.g. ankle-brachial index) in concert with imaging and vascular studies (e.g. duplex ultrasound) is necessary to arrive at an accurate diagnosis. The mean time from symptom onset to diagnosis is 3 years. Conservative interventions, which consist of bike hardware adjustments and/or posture modifications while riding, are generally not acceptable for a competitive cyclist. Surgical interventions take the form of percutaneous/endoscopic (e.g. balloon angioplasty, stent insertion) or open procedures (e.g. arterial release, endarterectomy, artery reconstruction) to restore arterial flow. Long-term outcomes following percutaneous procedures have followed a finite number of patients to date and are not recommended as a primary intervention for EIAE. Outcomes following open surgical procedures are strong with most riders being able to return to preinjury levels of competition. Greater awareness of EIAE among the scientific and medical community who work with cyclists is needed to improve the efficiency and overall management of EIAE.

Fabrication and characterization of a multilayered membrane for biliary stents enabling directional delivery of UDCA and aspirin

Choledocholithiasis detected during laparoscopic cholecystectomy is common. There is no consensus for the best management in this context. Trans-cystic biliary stent insertion is a well described but less commonly used method for managing choledocholithiasis with the gallbladder insitu. Retrospective study including all patients undergoing trans-cystic biliary stenting followed by ERCP at Box Hill Hospital, from 2021 to 2024. Outcomes compared to control cohort of native ERCP for choledocholithiasis at the same institution. The primary outcome was post-ERCP pancreatitis. Trans-cystic stenting was attempted in 49 patients. 45 (92%) were successful. The median age was 52 years, 73.4% were female, and 67% admitted emergently. No episodes of post-ERCP pancreatitis occurred when the trans-cystic stent was in position at ERCP, compared with 5% in the control cohort. Biliary cannulation rate was 97% if a stent was present, compared with 91% in the control cohort. 20% of stents had migrated by the time of ERCP. One patient developed pancreatitis post failed trans-cystic stent attempt. No other complications were recorded. The median length of stay (LOS) was 5.0 days. A 40% of patients were discharged prior to ERCP, resulting in a shorter median LOS: 4.0 versus 6.0 days (p = 0.014). No statistical differences were detected between variables for unsuccessful stenting, stent mis-deployment, or stent migration. Trans-cystic stenting resulted in a low rate of post-ERCP pancreatitis and a high rate of biliary cannulation. It can be safely implemented by general surgeons and may result in a reduced length of stay.

To evaluate the efficacy of fosfomycin trometamol powder (FMT) in preventing biofilm-associated bacterial infections on double-J stents in diabetic patients; to characterize the species distribution and antimicrobial susceptibility patterns of biofilm-forming bacteria isolated from these devices; and to identify clinical and microbiological risk factors associated with such infections-thereby informing evidence-based strategies for infection prevention in this high-risk population. A total of 100 adult diabetic patients who underwent double-J stent placement at our tertiary care center between June 2024 and June 2025 were prospectively enrolled and randomized in a 1:1 ratio to either an experimental group or a control group (n = 50 per group). Patients in the experimental group received a single oral dose of 3g FMT on the day before stent insertion and on postoperative days 7 and 15; those in the control group received a single oral dose of 0.5g levofloxacin (LFX) tablets on the day before stent insertion and on postoperative days 1 and 2. At the time of stent removal, stent surface specimens were collected for quantitative biofilm-forming bacterial culture, species identification, and antimicrobial susceptibility testing. Baseline clinical characteristics, stent-related symptoms, and infection outcomes were systematically recorded. Statistical analysis was conducted using SPSS version 26.0, with two-sided p < 0.05 considered statistically significant. Among the 100 diabetic patients with indwelling double-J stents, biofilm-forming bacterial colonization was detected in 24 (24.0%), with significantly lower prevalence in the experimental group (7/50, 14.0%) than in the control group (17/50, 34.0%) (χ2 = 5.48, p = 0.019). Escherichia coli (E. coli) was the predominant pathogen isolated (accounting for 50% of all positive cultures); among these E. coli isolates, 83.3% (10/12) were confirmed as extended-spectrum β-lactamase (ESBL)-producing strains. Gram-negative bacilli exhibited high-level resistance to ciprofloxacin (93.7%), ampicillin (100%), levofloxacin (87.5%), cefepime (68.7%), cefazolin (87.5%), cefuroxime (81.2%), and ceftriaxone (75.0%). Multivariable logistic regression identified age ≥ 60years, double-J stent indwelling duration ≥ 30days, daily fluid intake ≤ 2000mL, serum albumin < 30g/L, serum creatinine > 110μmol/L, and glycated hemoglobin (HbA1c) > 6% as independent risk factors for biofilm-associated bacterial infection (p < 0.05). When administered with equivalent dosing frequency (three doses total), FMT was associated with a significantly lower detection rate of biofilm-forming bacteria in double-J stent specimens compared with LFX among diabetic patients. These findings support the preferential use of FMT over LFX for targeted prophylaxis in high-risk diabetic populations and underscore the importance of integrating antimicrobial stewardship-particularly agent selection aligned with local resistance patterns-with proactive management of modifiable risk factors to optimize infection prevention and clinical outcomes.

Background: Lemmel syndrome is a rare cause of obstructive jaundice resulting from extrinsic compression of the common bile duct (CBD) by a periampullary duodenal diverticulum. It occurs in the absence of choledocholithiasis or malignancy and is frequently overlooked due to its nonspecific clinical presentation. Case Presentation: A 74-year-old male presented with progressive jaundice, intermittent fever, pruritus, dyspepsia, and upper abdominal discomfort for one month. Initial investigations demonstrated biliary dilatation without evidence of choledocholithiasis. Contrast-enhanced computed tomography (CECT) and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a large periampullary duodenal diverticulum compressing the distal CBD, consistent with Lemmel syndrome. Despite endoscopic therapy and medical management, the patient developed persistent cholangitis and worsening jaundice. Surgical exploration was performed, and cholecystectomy with choledochotomy, CBD stent insertion, and peritoneal toileting were carried out. No gallstones or CBD stones were identified intraoperatively. The postoperative course was uneventful, with progressive normalization of liver function tests and resolution of jaundice. Conclusion: Lemmel syndrome is an uncommon but important differential diagnosis in elderly patients with obstructive jaundice. Awareness of this entity and appropriate imaging are essential for early diagnosis. Endoscopic therapy is the preferred initial approach, but surgical intervention provides effective treatment when endoscopic management fails.

Middle cerebral artery (MCA) anatomy is essential to prevent catastrophe during intravascular procedures such as thrombolysis and cerebral angiography and neurosurgical practices, example - stent insertion, bypass grafting, etc. Eighty percent of blood supply to the brain is through MCA. The motor and sensory homunculus of brain representing arm and face receive blood supply from MCA. MCA consists of four segments. M1 is between the origin of MCA and the genu of insula (sphenoidal); M2 runs from limen insula to insula's circular sulcu (insular) s; M3 from circular sulcus to Sylvian fissure surface (opercular). Cortical branches of MCA territory can be divided into 13 areas orbitofrontal, prefrontal, precentral, central, postcentral, anterior parietal, posterior parietal, angular, temporo-occipital, posterior temporal, middle temporal, anterior temporal, and temporopolar arteries. MCA with bifurcated termination is seen in 64.70%. Bilateral bifurcation of MCA is present in 50%. Unilateral bifurcation of MCA is present in 25.45% on the left side and in 24.54% on the right side. MCA with trifurcated termination is seen in 12.35%. Bilateral trifurcation is present in 14.28%. Unilateral trifurcation is seen in 28.57% on the left side and 57.14% on the right side. Quadrifurcated type of termination is seen in 2.35%, four on the right side and four on the left side. Different sites of accessory MCA are at the level of proximal A1, at the level of middle A1, at the level of distal A1, at the level of Anterior communicating artery (AComA) at the level of A2. M1 segment (sphenoidal) of MCA is either straight or curved, where it is more curved than straight. The volume of this segment is more on the left side in males as compared to females. Average length of M1 segment is 17.30 ± 0.07 mm. Length is more on the left side as compared to the right side; it is more on nonaneurysmal side as compared to aneurysmal side. Again, the average diameter of M1 segment of MCA is 2.37 ± 0.33 mm, which is more on the left side and in male populations, diameter is more on aneurysmal side as compared to nonaneurysmal side. Diameter of M2 segment is more on left side (0.8-2.6 mm), and it is also more in case of females as compared to males. The M3 segment has been found to be more on the left side (1.5 mm as compared to right side1.4 mm. MCA fenestration is the name given to a fusion defect in the main trunk of the MCA after its origin, such that it emerges as a single trunk, branches, and then re-fuses. CRD number-420251052884.

Endoscopic Transpapillary Gallbladder Stenting for Complicated Cholecystitis in Patients With Cirrhosis and High Surgical Risk: An Observational Study.

Esophageal tumor perforation is a serious complication, seen in patients undergoing chemo-radiotherapy for advanced-stage cancer, and can lead to life-threatening conditions like sepsis and empyema. Esophageal stenting with self-expandable metal stents offers a safer, less invasive alternative to surgery, helping restore oral intake and improve patient comfort. This study aims to determine the effectiveness of esophageal stenting in managing esophageal tumor perforation at different disease stages and to assess long-term outcomes. This retrospective cohort study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center in Peshawar by reviewing 600 patient records presenting with esophageal tumor perforation from January 2016 to December 2021, and retracted between October and December 2024. Eighty patients who underwent esophageal stenting were enrolled in the study. Data on demographics, tumor characteristics, treatment history, and survival status were collected from the hospital's electronic system. SPSS-25 was used for analysis purposes. The chi-square test was employed to determine statistical significance (p ≤ 0.05). The mean age of patients was 46.98±11.62 years, and most patients were male (45, 56.3%). Squamous cell carcinoma was the most prevalent histological type, accounting for 74(92.5%) of cases. Advanced-stage disease was observed in the majority of cases, with T3 at 48 (60.5%) and T4 at 15 (18.8%). Additionally, 34(42.5%) exhibited nodal involvement (N1 and N2 each) and 23(28.7%) had metastatic. The median stent insertion during the study period was 83 days, with a range from 1 day to 7 years. Survival status was suboptimal, with 76(95%) deceased, 4(5%) surviving. Kaplan-Meier analysis demonstrates a median survival of 200 days. Esophageal stenting is an effective palliative intervention for managing tumor-induced esophageal perforation, particularly in patients with advanced disease, and prolongs survival.

Takayasu arteritis is a large-vessel vasculitis characterized by chronic inflammatory lesions that frequently lead to stenosis and occlusion of the common carotid artery (CCA). Endovascular revascularization for these inflammatory lesions is particularly challenging because the fibrotic and calcified vessel walls frequently hinder the passage of wires and catheters from a conventional antegrade approach. The authors report the case of a 57-year-old female with Takayasu arteritis who presented with a chronic total occlusion of the right CCA. The initial antegrade endovascular attempt resulted in wire dissection, necessitating an alternative strategy. They successfully performed retrograde recanalization via surgical cutdown of the superficial temporal artery (STA). A pull-through technique was utilized to establish a wire rail, which enabled safe and effective placement of the stent across the occluded segment. The patient's postoperative course was uneventful. The present case illustrates that a retrograde approach from the STA is a viable and effective alternative strategy for treating challenging CCA occlusions in patients with Takayasu arteritis. This technique expands the therapeutic options for complex vascular lesions that might otherwise be considered untreatable using conventional methods. https://thejns.org/doi/10.3171/CASE25897.

To describe a novel laparoscopic technique, prophylactic ureteral suturing (PUS), developed to reinforce structurally weakened ureteral segments following extensive ureterolysis for deep endometriosis, to avoid segmental resection or reimplantation. In selected patients with deep ureteral endometriosis, circumferential periureteral fibrosis was dissected after cystoscopic insertion of a double-J ureteral stent. Laparoscopic ureterolysis restored ureteral mobility and revealed a mucosa-only segment, considered at high risk of postoperative stricture or rupture, resulting from complete loss of the muscularis layer. The muscularis layers proximal and distal to the mucosal tract were then gently mobilized and reapproximated using interrupted absorbable 3-0 polyglactin sutures, avoiding mucosal penetration. This suture-based reconstruction restored circumferential wall support while maintaining luminal patency. An observational study was conducted on a cohort of 6 patients using the novel technique. No intraoperative or postoperative complications were observed. Renal function was preserved in all cases. Among three patients with preoperative hydronephrosis and elevated creatinine, imaging confirmed resolution of obstruction and normalization of renal parameters at follow-up. Prophylactic ureteral suturing may represent a safe and effective conservative alternative to reconstructive procedures in cases of ureteral muscularis loss during ureterolysis. The approach is technically straightforward, preserves ureteral continuity and the native antireflux mechanism, and can be integrated into standard laparoscopic treatment of urinary tract endometriosis. Further studies are warranted to confirm its long-term safety and broader applicability.

Side-by-side plastic stent insertion for refractory post-endoscopic sphincterotomy bleeding after covered metal stent placement

Multiple bile ducts (MBDs) in liver grafts present a significant risk for biliary complications (BCs) following living donor liver transplantation (LDLT). However, a standardized approach for managing these cases remains unclear. We aim to evaluate various biliary reconstruction procedures and identify the most effective strategies for minimizing complications. We conducted a retrospective analysis of 1780 microsurgical biliary reconstructions in LDLT between 2006 and 2022. Outcomes were assessed based on the conduit used and anastomotic techniques, focusing on duct-to-duct reconstructions and duct-to-jejunum (D-J) anastomoses. Technical refinements, including biliary stent insertion, ipsilateral bile duct anastomosis, figure-of-8 suturing over the junction of anastomosis, and centralization anastomosis for size discrepancies, were applied. Among the 1780 LDLTs, 23.1% have MBDs. The BC rate for single bile ducts was 11.2% (131/1169), while MBDs had 14.7% (58/394). BLs were significantly higher in MBD grafts compared with single bile ducts (6.1% vs. 2.1%, p =0.001), with no significant difference in stricture formation ( p =0.76). In adult LDLT using right lobe graft, the 2-to-2 duct-to-duct reconstructions had the highest BC rate of 16.6% (25/150), while D-J anastomoses with 2-to-2 configuration had the lowest BC rate of 0% (0/21). Overall, there were significantly higher BCs among duct-to-duct than D-J anastomoses (12.5% vs 2.6%, p =0.001) in adult LDLT using right lobe graft. D-J anastomoses offer a viable alternative with fewer complications for MBDs. Tailored strategies and technical refinements can mitigate the complications associated with MBD reconstruction.

A 56-year-old female presented to our emergency department in July 2023 with right flank pain and fever. Her past medical history included gastro-oesophageal reflux, hypertension, uterine fibroids and Graves' disease. She had presented to her general practitioner 11 months prior (August 2022) with rapid onset midline low back pain (with no preceding trauma or neurological symptoms) that resolved spontaneously. She had no history of urinary tract infection (UTI). On arrival, she had a urine dipstick (and subsequent microscopy, culture and sensitivity) indicating a UTI, elevated inflammatory markers and a computed tomography kidney, ureter, bladder (CT KUB) showing bulky uterine fibroids thought to be responsible for her significant right-sided hydronephrosis. She had normal renal function at the time of presentation. She underwent a rigid cystoscopy, retrograde pyelogram (RGP) and insertion of a right ureteric stent. Upon cannulation of her ureteric orifice, frank pus was observed. It was noted that her ureter calibre narrowed at the proximal ureter. Her discharge plan was for hysterectomy to definitively treat uterine fibroids, the presumed cause of her right-sided hydroureteronephrosis. In October 2023, post-hysterectomy, her right ureteric stent was removed and noted to be grossly encrusted. Her urine was cultured, showing two species of Candida, which were treated with antifungal medication. She gave a history of recurrent UTIs since her initial presentation in July. She had a follow-up computed tomography intravenous pyelogram (CT IVP) in December 2023, which showed unchanged hydronephrosis (despite hysterectomy), right-sided proximal ureteric structuring and a foreign body (reported to be a fishbone by the reporting radiology team) within her gastrointestinal tract (Figure 1). Her renal function remained within normal limits. She underwent a gastroscopy in December 2023, during which moderate gastritis and duodenitis were noted, and no foreign body was visualised. In January 2024, the patient underwent rigid cystoscopy and RGP; during which, contrast was noted in the duodenum (Figure 1), suggesting fistulation caused by the foreign body. The patient underwent a repeat gastroscopy the next day, and the foreign body was removed and found to be a toothpick (not a fish bone as previously reported by the radiology team). The patient was followed up in March 2024 with a rigid cystoscopy + RGP, which showed no further contrast within the duodenum and thus presumed resolution of her fistula. Subsequent urine MCS were negative for UTI, and her renal function remained stable and within normal limits. It took over 18 months from the onset of this patient's first symptom (back pain; August 2022) until the time of treatment (removal of toothpick, January 2024). While digestive tract foreign bodies are relatively common occurrences, with migration into other organs being rare but dangerous and an important differential to consider.1, 2 Most (80% to 90%) of foreign bodies pass spontaneously; however, sharp foreign bodies such as toothpicks and fishbones may lead to gastrointestinal perforation in 10% to 15% of cases and have been shown to lead to sepsis, liver abscess, appendicitis and peritonitis.1, 3-5 Unfortunately, there was a six-month period from the time of presentation to the hospital until eventual diagnosis for our patient, during which she had multiple minor operations and a major operation—a hysterectomy. Throughout this time, she also had multiple computed tomography scans, none of which reported the presence of a foreign body at the time of reporting nor on subsequent review after identification of the foreign body. Her delay in correct diagnosis is likely due to the presence of generalised urinary sepsis symptoms. Additionally, the patient reported no recollection of foreign body ingestion, thus presumed to be a case of accidental ingestion. Additionally, other signs such as haematuria have been noted in prior cases but were not observed in this case.1, 6 Additionally, back pain is a common sign in other reported cases; however, our patient had a single isolated incident of back pain a year prior that resolved spontaneously and is of unclear significance in this case.1, 6 When treating patients with urinary sepsis, it is important to consider renal foreign bodies as an alternative diagnosis to ensure patients are treated appropriately and without delay. The authors declare no conflicts of interest. The corresponding author is not a recipient of a research scholarship. This paper has not been submitted elsewhere. There is one figure included in this paper.

ABSTRACTPresented here is an extremely rare case of bilateral ureteral obstruction due to Candida albicans fungus balls, which led to acute kidney dysfunction and candidemia. An 83‐year‐old man was brought to our hospital after falling due to poor physical condition. He had been receiving abiraterone acetate for 1 month for metastatic castration‐resistant prostate cancer, while past medical history included type II diabetes, cardiovascular disease, and dementia. Blood test results revealed severe liver dysfunction, though whole‐body computed tomography (CT) findings showed no abnormalities. Based on the recent therapy course, the patient was diagnosed with drug‐induced liver damage caused by abiraterone acetate, and steroid pulse therapy and antibiotic administration were started. On Day 11 after starting that treatment, decreased urine output and renal dysfunction were noted. CT scanning revealed bilateral hydronephrosis and slightly dense masses at the origin of ureteral obstruction on both sides. Subsequently, C. albicans was detected in blood and urine samples, thus fungus balls were determined as the cause of bilateral hydronephrosis. Temporary hemodialysis was required, though clinical symptoms and biochemical findings gradually improved following insertion of bilateral ureteral stents and administration of antifungal therapy, and the patient was discharged 72 days after admission.

The present study compared the clinical outcomes and indications of metallic ureteral stents (MS) and polymeric ureteral stents (PS) in patients with malignant ureteral obstruction (MUO). We analyzed 148 patients (240 ureters) with MUO who underwent ureteral stent placement at our Department of Urology between December 2014 and April 2022. The cohort included 67 patients (112 ureters) who received metallic stents (MS group) and 81 patients (128 ureters) who received polymeric stents (PS group). We evaluated overall survival and the primary underlying malignancies, and compared operative times, ureteral stent patency rates, and factors associated with stent obstruction between the two groups. The one-year overall survival rate of patients with MUO was 27.2%, with a median survival time of 209 days. The main primary malignancies were gynecologic and gastrointestinal cancers, most commonly cervical, gastric, colorectal, breast, and ovarian cancers, in that order. The operative time for stent insertion was significantly longer in the MS group than in the PS group for both bilateral (p = 0.0004) and unilateral (p = 0.0094) placements. The one-year stent patency rate was significantly higher in the MS group (62.0%) than in the PS group (48.5%) (p = 0.0144). Factors associated with stent obstruction included lower ureteral obstruction (p = 0.0401), direct tumor compression (p = 0.0172), pyuria (p = 0.0028), and elevated preoperative serum creatinine (p = 0.0088) in the MS group, and peritoneal dissemination (p = 0.0005) in the PS group. A comparison of stent patency between the groups according to obstruction factors showed no significant differences for lower ureteral obstruction (p = 0.5140), direct tumor compression (p = 0.8215), or pyuria (p = 0.8401). However, among patients with peritoneal dissemination, the stent patency period was significantly longer in the MS group (p = 0.0001). Metallic ureteral stenting, which has higher patency rates than PS, is a safe and effective treatment option for MUO, particularly in the patients with peritoneal dissemination.