Ureteral Stenting In Patients Research Articles

Letter to the Editor: Risk of Metachronous Upper Tract Urothelial Carcinoma After Ureteral Stenting In Patients With Bladder Cancer

Letter to the Editor: Risk of Metachronous Upper Tract Urothelial Carcinoma After Ureteral Stenting In Patients With Bladder Cancer

Ureteral stenting in patients with locally advanced cervical cancer: Predictors of low success rate

ObjectiveCervical cancer is the leading gynecologic malignancy in Ethiopia. The diagnosis is often delayed and many patients present with locally advanced disease. Involvement of the ureters with or without the development of hydroureteronephrosis is a common finding. Ureteral stent placement is a modality utilized to relieve an established obstruction (therapeutic) or to prevent its early occurrence (prophylactic). However, the procedure may not be successful in all patients. The objective of this study is to assess the factors associated with low success rate of ureteral stenting in these patients with locally advanced disease. MethodsThis is a hospital based cross-sectional study of patients diagnosed with locally advanced cervical cancer for whom a retrograde ureteral stent placement is attempted from January 2019 to March 2020. Data of 175 patients were retrieved by a retrospective chart review and analyzed for factors associated with low procedural success. ResultsSocio-demographic data were similar between patients regardless of procedural success. The overall success rate of stenting was 54.2 %. In the prophylactic group (with no hydronephrosis and normal creatinine) success rate was 94 % and in the therapeutic group 42.6 %. Logistic regression analysis showed that bilateral hydronephrosis and increased serum creatinine were indicators of significant ureteral obstruction and were predictors of stent placement failure. ConclusionIncreased serum creatinine and presence of hydronephrosis are risk factors for failed ureteral stenting. For these patients, other options of urinary diversion such as percutaneous nephrostomy should be considered from the outset.

Migration of double-J ureteral stent in patients with ureteroileal anastomosis stricture undergoing radical cystectomy and orthotopic neobladder: Analysis risk factors of stent migration.

The objective was to evaluate the incidence and degree of double-J ureteral stent (DJUS) migration. Additionally, we aimed to investigate the risk factors associated with stent migration in the orthotopic neobladder group. In this retrospective study, 61 consecutive patients were included; 35 patients (45 DJUS placements) underwent radical cystectomy with orthotopic neobladder and 26 patients (35 DJUS placements) underwent urinary bladder without cystectomy between July 2021 and March 2023. All the patients were treated with a DJUS for ureteric strictures. The technical success rate was 100% in each group. The DJUS migration was significantly higher in the orthotopic neobladder group, with 22 of 45 cases (48.9%), compared to the urinary bladder group, which had 4 of 35 cases (11.4%) (P ≤ .001). Among the patients in the orthotopic neobladder group who experienced DJUS migration, stent dysfunction occurred in 18 cases (81.8%), which was statistically significant (P = .003). Multivariate logistic regression analysis revealed that only the size of the DJUS was significantly and positively associated with migration (odds ratio:10.214, P = .010). DJUS migration can easily occur in patients undergoing radical cystectomy and orthotopic neobladder, and smaller stent sizes are associated with a higher incidence of migration.

Cystoscopy and Placement of Ureteral Stents: Preoperative for HIPEC Surgery

Cytoreductive debulking surgeries can be complicated by difficulty identifying the course of the ureters in the retroperitoneum due to exacerbation by any anatomical distortion from tumor burden or history of previous intra-abdominal operations. Inadvertent direct injury to or devascularization of the ureters or the rest of the lower urinary system during the course of these procedures is a serious concern and can result in increased morbidity for the patient. In order to reduce these risks, urologists often prophylactically place ureteral stents in patients preoperatively in order to aid surgical oncologists in readily identifying the course of the ureters during surgery. Here we present the prophylactic ureteral stenting of a patient undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy for extensive appendiceal adenocarcinoma metastasis. We outline the proper cystoscopic technique, identification of the ureteral orifices, stent placement, bladder inspection, and how to secure the stents with the Foley catheter. The stents were placed without incident and without encountering any resistance, suggesting the ureters were not heavily involved with the tumor. Inspection of the bladder revealed no unusual indentation, extrinsic pressure, masses, or other pathology.

The Allium Ureteral Stent for the Treatment of Ureteral Complications Following Renal Transplantation-A Single-Center, Single-Surgeon Series.

Ureteral complications such as urinary leak, ureteral necrosis or ureteral stenosis are common complications after renal transplantation with major short- and long-term issues, including graft impairment and graft loss. At present, there is no agreement on the optimal management of ureteral complications. The aim of the current study was to evaluate the safety and efficacy of the self-expanding, large-caliber Allium ureteral stent in patients with ureteral complications following renal transplantation. In this retrospective study, the electronic database of Charité University Hospital was screened for patients receiving the self-expandable Allium ureteral stent in the transplant ureter after kidney transplantation between January 2016 and March 2022. Descriptive statistics were used to describe the outcomes. There were six men and four women with a median age of 61 years (interquartile range, 55 to 68 years). Nine out of 10 patients had ureteric stenosis, which was diagnosed at a median of two years (interquartile range 10 months to 9 years) following renal transplantation. The median operating time was 49 min (interquartile range, 30 to 60 min). Endoscopic Allium stent placement was successful in all patients with ureteric stenosis. The median length of stay in the hospital was four days (interquartile range 2 to 7 days). Only one patient (#5) had a postoperative grade IIIb Clavien-Dindo complication. Patients had follow-ups every 3 months with ultrasound and serum creatinine. Dislocation of the Allium stent was seen in four patients; all occurred within three months. Ultimately, three patients required ureteric re-implantation, two of which had early dislocation of the stent. Six patients are managed with a permanent Allium stent. The median dwell time was 11 months (interquartile range 3 to 20 months) and maximum dwell time was 23 months. The overall success rate was 60% (6 out of 10). According to our data, the Allium stent represents a safe and minimally invasive option with a success rate of 60%. It might, therefore, represent an alternative to DJ stents, nephrostomies or immediate re-implantation. As all dislocations occurred within three months, frequent early postoperative follow-up is required.

Renal tamponade in a patient with hydronephrosis-related Page kidney.

A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.

Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies.

We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI.Statistical significance was set two-tail p-value < 0.05 Results: Ten studies were included. Procedure time (MD -10.26 minutes 95%CI -12.40-8.02, p< 0.00001), hospital stay (MD -1.30 days 95%CI -1.69 - -0.92, p< 0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p< 0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival. Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.

Patency period of a metallic ureteral stent and its determinants in patients with malignant ureteral obstruction: a prospective review

BackgroundMalignant ureteral obstruction caused by extrinsic compression of a primary malignant tumour or by metastatic disease is an indicator of poor prognosis with a median life expectancy of about one year. We examined clinical outcomes following Resonance Metallic Ureteral Stent (Cook Medical, Bloomington, IN) placement in patients with malignant ureteral obstruction.MethodsThis was a prospective study of patients with malignant ureteral obstruction who underwent Resonance Metallic Ureteral Stent placement from April 2016 to March 2021. We registered 21 patients (27 collecting systems) with malignant ureteral obstruction and observed them prospectively. The patients first underwent polymer ureteral stent placement followed by replacement with a metallic ureteral stent one month later. Primary outcome was the metallic ureteral stent patency period based on both serum creatinine and the level of hydronephrosis; secondary outcomes were factors affecting patency period and stent-related complications such as symptoms of obstruction (flank pain), bladder irritation, haematuria, and urinary tract infection (presence or absence of fever).ResultsThe study comprised 21 patients (six men, 15 women) with a mean age of 72 years. The median stent patency period in days was not available (NA) (95% CI 210–NA) due to the inability to extract this value from the Kaplan–Meier curve because the event rate did not reach 50%, and the one-year patency rate was 59.2% (95% CI 23.2–82.9). A normal serum creatinine (0.65 to 1.07 mg/dL for men and 0.46 to 0.79 mg/dL for women) one week after polymer ureteral stent placement was a significant factor affecting the long-term metallic ureteral stent patency period. There were no major complications.ConclusionThe Resonance Metallic Ureteral Stent was effective and safe for patients with malignant ureteral obstruction. A normal serum creatinine level one week after placement of a polymer ureteral stent may predict a longer patency period of metallic ureteral stents in patients with malignant ureteral obstruction.

MP65-17 IS PRIMARY URETEROSCOPY MORE COST-EFFECTIVE THAN URETERAL STENTING FOR OBSTRUCTING URETERAL CALCULI?

INTRODUCTION AND OBJECTIVE: The increasing prevalence of nephrolithiasis represents a significant economic burden worldwide making cost-reduction essential. Given that 20% of patients with ureteral colic require acute surgical intervention, there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a costeffectiveness analysis between primary treatment and ureteral stenting in patients with ureteral stones in the emergency setting. METHODS: We performed a retrospective analysis of patients requiring emergency intervention for a ureteral calculus at a single institution between January and December 2019. All patients underwent ureteral stenting, primary ureteroscopy (URS) or shock wave lithotripsy (SWL). The overall secondary care cost was calculated to include the cost of the procedure, inpatient hospital bed days, emergency room (ER) attendances, additional procedures such as nephrostomy insertion and secondary definitive procedure. RESULTS: A total of 244 patients were included. Ureteral stenting was performed in 152 patients (62.3%) and primary treatment in 92 patients (37.7%), of those, 83 patients (34.0%) underwent primary URS and 9 patients (3.6%) had SWL. Those undergoing ureteral stenting had a significantly higher ER reattendance rate (25.7% vs 10.9%, >p=0.02). The overall secondary care cost was greater in the ureteral stenting group (£4485.42 vs £3536.83;>p=0.65). The average cost per patient related to ER reattendances was significantly higher in the ureteral stenting group compared with the primary treatment group (£61.05 vs £20.87;>p < 0.001). CONCLUSIONS: The current study highlights the potential overall cost-reduction when performing primary treatment in patients presenting with acute ureteral colic, predominantly related to reduced ER attendances. This is particularly relevant in the COVID-19 pandemic where it is crucial to avoid unnecessary attendances to the ER and reduce the backlog of delayed definitive procedures. Both primary URS and SWL in the acute setting should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.

Immediate Shockwave Lithotripsy vs Delayed Shockwave Lithotripsy After Urgent Ureteral Stenting in Patients with Ureteral or Pyeloureteral Urolithiasis: A Matched-Pair Analysis.

Introduction: The most common cause of acute renal colic is a ureteral obstruction caused by ureterolithiasis. Urgent intervention is often necessary due to intractable pain. Early extracorporeal shockwave lithotripsy (SWL) as an alternative treatment option to ureteral stenting becomes forgotten in times of rising ureterorenoscopy. However, definitive guidelines are lacking, in which urgent treatment should be preferred in the absence of signs of infection. Therefore, we assessed efficacy and safety of early SWL (eSWL) to secondary SWL (sSWL) after urgent ureteral stenting. Patients and Methods: One hundred four patients treated between January 2015 and November 2017 for obstructive ureterolithiasis were matched regarding stone size, stone localization, and assigned to group eSWL (n = 52) or group sSWL (n = 52). The eSWL group received shock waves (without prior ureteral stenting) and sSWL group ureteral stenting within 48 hours from diagnosis. Thereafter, patients in group sSWL were treated with shock waves for a median of 23 ± 14.6 days after ureteral stenting. Stone-free rates, complication rates, and reintervention rates were assessed. Univariable and multivariable logistic regression was applied to find predictors of outcomes in the two treatment groups. Results: Overall, there was no statistically significant difference between both groups regarding stone-free rate and complication rate. Reinterventions were more often addressed for patients in group sSWL (p = 0.05). eSWL was significantly superior to sSWL regarding stone-free rates for stones between 6 and 9 mm (p = 0.04). At the multivariable multinomial logistic regression none of the two treatment modalities was associated with better outcomes. A body mass index ≥30 was associated with a reduced 6-week stone-free status (p = 0.04), whereas stones ≥8 mm were associated with an increased need of reintervention (p = 0.04). Conclusion: eSWL seems to be an effective and safe emergency procedure compared with sSWL after urgent stenting within 6 weeks and should be considered as a treatment option in patients without absolute indications for immediate ureteral drainage. Clinical trial registration number: 2019-00155.

Does Ureteral Stenting Increase the Risk of Metachronous Upper Tract Urothelial Carcinoma in Patients with Bladder Tumors? A Systematic Review and Meta-analysis.

Ureteral stenting in patients with bladder cancer may become necessary in order to protect the ureteral orifice during transurethral resection of the tumor or for relief of upper urinary tract obstruction. However, it is believed to increase metachronous upper tract urothelial carcinoma risk. We performed a systematic review and meta-analysis of studies comparing ureteral stenting versus nephrostomy or no drainage with regard to the risk of metachronous upper tract urothelial carcinoma. Records were identified through database searches and sources of grey literature up to October 2020 (PROSPERO: CRD42020178298). Five studies (3,309 individuals) were included. Overall, 278 ureteral stents were placed and 20 (7.2%) patients developed metachronous upper tract urothelial carcinoma, while 131 patients were treated with nephrostomy and 3 (2.3%) cases of metachronous upper tract urothelial carcinoma occurred. Patients treated with ureteral stents had a higher likelihood of metachronous upper tract urothelial carcinoma compared to no stents (OR: 3.49, 95% CI: 1.43-8.48, I2=52%) and no upper urinary tract drainage (OR: 3.37, 95% CI: 1.49-7.63, I2=45%). No difference with regard to metachronous upper tract urothelial carcinoma was observed between stent and nephrostomy (OR: 3.07, 95% CI: 0.41-22.98, I2=54%). For the same outcomes, no difference was noted for patients with hydronephrosis. The level of evidence for all measures was evaluated as low. Stenting as a preventive measure after resection of tumors involving the orifice should be avoided, when possible, as it increases the risk of metachronous upper tract urothelial carcinoma. In cases of hydronephrosis, drainage with either nephrostomy or stent is recommended depending on individual patient cases as both interventions do not differ regarding metachronous upper tract urothelial carcinoma risk.

Risk Factors of Urinary Tract Infection After Ureteral Stenting in Patients with Renal Colic During Pregnancy.

Introduction: To investigate risk factors associated with urinary tract infection (UTI), following ureteral stenting, for patients with renal colic during pregnancy. Patients and Methods: Patients with renal colic during pregnancy who underwent ureteral stenting in The First Affiliated Hospital of Guangzhou Medical University between 2009 and 2019 were examined retrospectively. Ureteral stenting patients who had UTIs after hospital discharge and before delivery were classified as the infected group. Multivariate logistic regression analysis was used to assess the risk factors associated with UTI after ureteral stenting. Results: A total of 102 patients were enrolled into the study. Mean age was 30 years (interquartile range [IQR]: 26-33 years) and mean gestation age was 22 weeks (IQR: 18-28 weeks). UTI occurred in 21 patients (20.6%). Compared with noninfected patients, infected patients had a higher rate of positive urine culture (52.4% vs 13.6%, p = 0.000), kidney stones ≥10 mm (81% vs 35.8%, p = 0.000), residual stones after ureteral stenting (71.4% vs 43.2%, p = 0.021), and different surgical indications and gestational ages (18 vs 23 weeks, p = 0.00). Multifactor analysis showed that gestational age, positive urine culture (odds ratio [OR] = 6.233, 95% confidence interval [CI]: 1.830-21.227), and stones ≥10 mm (OR = 0.124, 95% CI: 0.031-0.495) were independent risk factors for UTI after ureteral stenting in patients with renal colic. In the infection group, Escherichia coli was the most commonly found organism (47.4%). Conclusions: Gestational age, positive urine culture before surgery, and stone ≥10 mm were risk factors for UTI after ureteral stenting in pregnant patients with renal colic. E. coli was the main pathogen of UTI after this procedure. Preoperative anti-infection treatment needs to be based on drugs that are sensitive to E. coli.

Encrustations on ureteral stents from patients without urinary tract infection reveal distinct urotypes and a low bacterial load

BackgroundCurrent knowledge of the urinary tract microbiome is limited to urine analysis and analysis of biofilms formed on Foley catheters. Bacterial biofilms on ureteral stents have rarely been investigated, and no cultivation-independent data are available on the microbiome of the encrustations on the stents.ResultsThe typical encrustations of organic and inorganic urine-derived material, including microbial biofilms formed during 3–6 weeks on ureteral stents in patients treated for kidney and ureteral stones, and without reported urinary tract infection at the time of stent insertion, were analysed. Next-generation sequencing of the 16S rRNA gene V3–V4 region revealed presence of different urotypes, distinct bacterial communities. Analysis of bacterial load was performed by combining quantification of 16S rRNA gene copy numbers by qPCR with microscopy and cultivation-dependent analysis methods, which revealed that ureteral stent biofilms mostly contain low numbers of bacteria. Fluorescence microscopy indicates the presence of extracellular DNA. Bacteria identified in biofilms by microscopy had mostly morphogenic similarities to gram-positive bacteria, in few cases to Lactobacillus and Corynebacterium, while sequencing showed many additional bacterial genera. Weddellite crystals were absent in biofilms of patients with Enterobacterales and Corynebacterium-dominated microbiomes.ConclusionsThis study provides novel insights into the bacterial burden in ureteral stent encrustations and the urinary tract microbiome. Short-term (3–6 weeks) ureteral stenting is associated with a low load of viable and visible bacteria in ureteral stent encrustations, which may be different from long-term stenting. Patients could be classified according to different urotypes, some of which were dominated by potentially pathogenic species. Facultative pathogens however appear to be a common feature in patients without clinically manifested urinary tract infection.Trial registrationClinicalTrials.gov, NCT02845726. Registered on 30 June 2016—retrospectively registered.

Efficacy and safety of the use of infant feeding tubes as internal ureteral stents at Muhimbili National Hospital, Tanzania

Background: Infant feeding tubes are inexpensive, readily available, and have been used as urinary tract stents with some uncertainty about their effectiveness and safety. Double J ureteral stents are available on the market, but among other factors, availability and affordability limit their use in developing countries, including in our hospital. We aimed to compare the efficacy of infant feeding tubes compared to standard double J ureteral stents in patients undergoing open ureteral stenting at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: We conducted a hospital-based cross-sectional analytical study over 12 months. Patients included in the study required open ureteral stenting for different indications and were divided into 2 groups: those for whom infant feeding tubes were inserted during surgery (study group) and those whose surgery used double J stents (control group). After surgery, patients were recruited and observed to ascertain the duration of hospital stay, as well as the presence of haematuria, dysuria, urinary frequency, flank and suprapubic pain, stent migration, and stent encrustation. Observations continued until the day of discharge, after which patients were followed up to the day of stent removal. Results: A total of 44 patients were enrolled in the study. The mean age of participants was 40 years (range 1 to 75). The majority of participants were female (n = 26; 60%). Among the 44 operations, 19 (43.2%) used the infant feeding tube as a stent whereas the remainder (n = 25; 56.8%) used the standard double J ureteral stent. The mean hospital stay among patients who underwent surgery with the infant feeding tube as a stent was 9.6 days, whereas those who used the standard double J stent stayed for 8.8 days (P = 0.37). Postoperatively, haematuria was observed in 19 (43.2%) of the patients; among these, 15 (79%) of them received infant feeding tube stents and 4 (4.3%) received standard double J stents (Χ2 = 17.4; P = 0.001). The postoperative prevalences of dysuria, flank pain, and suprapubic pain were 6.8%, 20.4%, and 9.1%, respectively. These outcomes did not show association with the type of surgical stent used. None of our study patients experienced postoperative urinary frequency. Imaging studies showed that 57.8% of the infant feeding tube stents were in the normal position postsurgery, whereas all of the standard double J stents were in the normal position (Χ2 = 12.86; P = 0.005). Further, we found that among the 44 patients, only 1 patient (who underwent surgery that used double J stenting) had postoperative stent encrustation (Χ2 = 0.7; P = 0.4). Conclusions: Despite producing significantly higher incidences of haematuria and malposition, infant feeding tube as ureteral stents were comparable to double J stents in terms of hospital stay post-stenting, dysuria, flank pain, suprapubic pain and encrustation. Future larger prospective studies are needed to confirm these findings. https://dx.doi.org/10.4314/ecajs.v22i3.5 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Abstract No. 573 Outcomes of ureteroplasty and stenting of anastomotic ureteral strictures occurring after urinary diversion and renal transplantation

To report outcomes of percutaneous ureteroplasty and stenting of anastomotic ureteral strictures which occurred within 1 year of urinary diversion (ureteroenteric anastomosis -UEA) or renal transplantation (ureterovesical anastomosis-UVA). We retrospectively identified patients who underwent ureteroplasty with percutaneous nephroureteral (PCNU) or double pigtail ureteral stent placement (stent) for benign anastomotic strictures occurring within one year of urinary diversion or renal transplantation from March 2004 to July 2016 (N = 54). 31 patients had UEA strictures (25 men and 6 women; mean age 65, 19 ileal conduits and 12 continent diversions) and 23 renal transplant patients had UVA strictures (15 men and 8 women; mean age 53). Mean follow-up was 31 months (range, 1.107 months). Primary endpoint was freedom from ureteral stent or nephrostomy without the need for surgical revision (i.e., tube free). Mean balloon diameter used for ureteroplasty in the urinary diversion and renal transplant cohorts was 7.7 mm and 6 mm, respectively (p < 0.01). Mean French size of PCNU or stent placed after ureteroplasty was 10 French. In the UEA group, 8/31 (25%) patients underwent surgical revision and 18/31 (58%) required chronic ureteral stents after failed ureteroplasty. Only 5/31(16%) were tube free without surgery. In the UVA cohort, 2/23 (8%) patients underwent surgical revision and 9/23 (39%) required chronic indwelling ureteral stents after failed ureteroplasty. 12/23 (52%) renal transplant patients were tube free without surgery. By Kaplan Meier analysis, the actuarial mean time to PCNU or stent removal was 81 ± 10 months and 41 ± 11 months for UEA and UVA respectively (p = 0.01). Ureteroplasty had greater success in achieving the primary endpoint of freedom from PCNU or ureteral stent in patients after renal transplantation as compared with patients after urinary diversion.

Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery.

Ureteral injuries are well-known complications of any gynecologic surgery. We evaluated the safety and feasibility of ureteroscopic double-J (DJ) ureteral stenting in patients with distal ureteral injuries after gynecologic surgery. Eleven consecutive patients with an iatrogenic ureteral injury in the distal ureter secondary to gynecologic surgery underwent DJ ureteral stenting between March 2008 and January 2016. Ureteral leakage and stricture were appraised using intravenous pyelography. The operative and clinical outcomes were evaluated. The DJ ureteral stent was successfully inserted using ureteroscopy in all patients, none of whom showed major or minor complications during the intraoperative and perioperative follow-up periods. Intravenous pyelography performed every 3months during the follow-up period verified recovery at the ureteral injury site, without urine leakage. However, five patients experienced ureteral stricture. Balloon dilatation or Holmium laser endoureterotomy was performed successfully in all patients. One patient with recurring ureteral stricture was retreated using Holmium laser endoureterotomy and balloon dilatation; during 12months of follow-up, there was no recurrence. Overall long-term success rate was 100%, with a mean follow-up of 20.4months. DJ stenting using ureteroscopy diminishes the necessity for invasive surgical procedures and is regarded as one of the available management options for patients with an iatrogenic ureteral injury before considering an invasive operation. However, since ureteral stricture frequently occurs after ureteroscopic procedures, it is essential to select the appropriate patients.

A single-institution experience with metallic ureteral stents: a cost-effective method of managing deficiencies in ureteral drainage.

The limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage. Fifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, or an elevation in serum creatinine. Stent life was analyzed using the Kaplan-Meier methodology, as this was a time dependent continuous variable. A cost analysis was similarly conducted. A total of 97 metallic stents were placed among our cohort of patients: 63 in cases of malignant obstruction, 33 in the setting of cutaneous ureterostomies, and 1 in an ileal conduit urinary diversion. Overall, stent failure occurred in 8.2% of the stents placed. Median stent life was 288.4 days (95% CI: 277.4-321.2 days). The estimated annual cost for traditional polymer stents (exchanged every 90 days) was $9,648-$13,128, while the estimated cost for metallic stents was $4,211-$5,313. Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications and is well tolerated among patients. Metallic stents can be left in situ for longer durations and provide a significant financial benefit when compared to traditional polymer stents.

Ureteral stenting in laparoscopic colorectal surgery

BackgroundFew studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes. MethodsThe 2005–2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents. ResultsA total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P < 0.001). However, there were no significant differences in morbidity or mortality. ConclusionsWe describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury.

Metallic Ureteral Stents in Malignant Ureteral Obstruction: Clinical Factors Predicting Stent Failure

To provide clinical outcomes of the Resonance metallic ureteral stent in patients with malignant ureteral obstruction, as well as clinical factors predicting stent failure. Cancer patients who have received Resonance stents from July 2009 to March 2012 for ureteral obstruction were included for chart review. Stent failure was detected by clinical symptoms, image studies, and renal function tests. Survival analysis for stent duration was used to estimate patency rate and factors predicting stent failure. A total of 117 stents were inserted successfully into 94 ureteral units in 79 patients. There were no major complications. These stents underwent survival analysis and proportional hazard regression. The median duration for the stents was 5.77 months. In multivariate analysis, age (P=0.043), preoperative serum creatinine level (P=0.0174), and cancer type (P=0.0494) were significant factors associated with stent failure. Cancer treatment before and after stent insertion had no effect on stent duration. Resonance stents are effective and safe in relieving malignant ureteral obstructions. Old age and high serum creatinine level are predictors for stent failure. Stents in patients with lower gastrointestinal cancers have longer functional duration.

Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies

To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure. The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure. A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3-476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3-263 days) and 6.5 months (range 4-476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4-398 days) and 7.8 months (range 31-476 days), respectively. Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration.