Ante-grade ureteric stenting, retrospective experience in managing 89 patients: Indications, complications and outcome

Abstract

Background: Over the past three decades there has been a remarkable increase in interventional uro-radiological procedures in the developed countries. Long-term drainage of the obstructed upper urinary tract may be achieved by percutaneous nephrostomy or ureteric stenting. Previously most ureteric stents were inserted by the retrograde approach at cystoscopy and these procedures have required the use of general or spinal anesthesia. With the development of a nephrostomy service in most hospitals throughout the world ante-grade ureteric stenting procedures are being carried out by trained interventional radiologists in the radiology department without the need for a general or spinal anesthesia. Aims/materials and methods:To review the records of all 89 patients who had insertion of ante-grade ureteric stents for ureteric obstruction between February 2010 and January 2013 in order to document the following: The causes of obstruction; The side (left, right or both sides) and site of the ureteric obstruction (upper, mid or lower ureter); The sex and ages of the patients; Success or failure of the procedure; Complications of procedure; The management of the complications.Results: Ante-grade ureteric stenting was successful in 105 out of 121 procedures (86.7%) which 89 patients underwent. Out of 105 successful ante-grade stenting procedures carried out, 103 were successful at first attempt, another two were successful at second attempt and one successful at a third attempt, making it a total of 105 successful procedures. There were minimal complications. Conclusion and recommendation:Ante-grade ureteric stenting is a safe procedure with minimal complications. Every radiology unit should have a trained interventional radiologist capable of performing ante-grade ureteric stenting.

Antegrade insertion of a double J catheter in the treatment of malignant ureteral obstruction: a retrospective analysis of the results obtained with a modified technique at a university hospital

“…Romero et al (11) obtained similar results. In the study conducted by Venyo et al (6) , the main obstructive neoplasm of the ureter was bladder cancer, followed by prostate cancer. Punctures performed using a posterolateral oblique approach to the upper collecting system, along the renal avascular plane (Brödel's line), allow easier access to the ureteropelvic junction and facilitates catheter manipulation in the direction of the ureter, as well as providing a safe, relatively avascular, puncture route (4,8,12) .…”

“…Punctures performed using a posterolateral oblique approach to the upper collecting system, along the renal avascular plane (Brödel's line), allow easier access to the ureteropelvic junction and facilitates catheter manipulation in the direction of the ureter, as well as providing a safe, relatively avascular, puncture route (4,8,12) . In antegrade pyelography with iodinated contrast injection and fluoroscopic visualization of the anatomy of the collecting system, decompression should be performed immediately after the proper positioning of the needle because, especially in patients with infected urine, because allowing the collecting system to be overly distended could lead to bacteremia (6) . In the present study, we observed that in punctures made through the upper calyces, positioning the rigid J-tipped guidewire and the 6 Fr × 45 cm introducer sheath inside the bladder resulted in straightening of a tortuous ureter in cases of megaureter, making it easier to insert the double J catheter.…”

“…When urgent relief of the obstruction is the single determining factor, percutaneous nephrostomy seems to be the most reliable approach in the scenario of malignancies, with lower chances of loss of drainage patency in the long term. However, the disadvantage of percutaneous nephrostomy is the need to use a collecting pouch, which has to be replaced regularly, causing discomfort and decreasing the quality of life of the patient, in addition to the increased risk of infection and displacement of the external drain (6,10) , which often results in the patient initially refusing the procedure.…”

“…Major complications associated with antegrade JJ stenting reportedly occur in 4-8% of cases and include the following (6,14) : heavy bleeding, which can be treated with angiographic embolization; inadvertent puncture of the pleura or abdominal viscera (bowel loops, liver, or spleen); and septicemia. Inadvertent damage to the intestine is a rare complication, occurring when the colon is in a retrorenal position (1) .…”

“…Double J catheters are normally inserted by a retrograde pathway under cystoscopic guidance. That approach, however, can be difficult, especially in patients with anatomical distortion of the bladder wall or malignant ureteral obstructions with involvement of a long ureteral segment, because of the technical inability to advance the guidewire beyond the point of obstruction; in such cases, the only options are percutaneous nephrostomy and antegrade insertion of a ureteral catheter (6) . The disadvantages of nephrostomy in relation to antegrade JJ stenting involve discomfort for the patient, a higher risk of infection, and displacement of the external drain (6)(7)(8) .…”