The Resonance and the Allium ureteral stents in the treatment of non-malignant refractory ureterostenosis

Abstract

Background Refractory non-malignant ureterostenosis is challenging to treat. The experience to treat the stenosis primarily cause by retroperitoneal fibrosis with the Resonance and Allium metallic stent is still limited. We aim to evaluate the efficacy and safety of these two stents and provide alternative treatment options. Methods A retrospective study was conducted for patients with non-malignant ureterostenosis and treated with the Resonance and Allium stents from March 2011 to September 2020 in our department. The efficacy was evaluated by the change of serum creatinine, glomerular filtration rate (GFR), the proportion of GFR of the affected side and hydronephrosis grade. The safety was evaluated by postoperative presence of moderate or severe overactive bladder (OAB), recurrent urinary infection, pain, stent displacement, encrustation and re-obstruction. Results 33 patients were eligible for the study, including 18 cases treated by the Resonance stents and 15 patients treated by the Allium stents. The patients of two groups had similar age and gender proportion. The cause of ureterostenosis was mainly retroperitoneal fibrosis in both groups but the Resonance group had more idiopathic cases. Follow-up time was significantly longer in the Resonance group than the Allium group (36.2 ± 24.0 vs 9.4 ± 5.0 months, p < 0.001). Both groups showed improvement or maintenance of serum creatinine level, GFR, the GFR proportion of the affected side and hydronephrosis grade after treatment. The Resonance group presented significant higher incidence of moderate or severe OAB, recurrent urinary infection and pain, while the Allium group showed significant more cases of re-obstruction. Conclusion Both the Resonance and Allium stent can relieve the non-malignant refractory ureterostenosis effectively. The Resonance stent may cause more irritable symptoms while the Allium stent may have a higher rate of re-obstruction. The long term efficacy and safety of the Allium stent in treating non-malignant refractory ureterostenosis requires further study.

Long-term maintenance treatment of recurrent ureteropelvic junction obstruction with covered metallic ureteral stent

“…[ 21 ] Our covered metallic ureteral stent migration rate (25%) is similar to a recent study using a covered metallic ureteral stent to treat nonmalignant refractory ureteral stricture with a stent migration rate of 26.67% (4/15). [ 5 ] However, our covered metallic ureteral stent migration rate is higher than a previous study using a covered metallic ureteral stent to treat recurrent ureteral stricture after ureteroplasty with a stent migration rate of 12.5% (3/24). [ 25 ] The previous study includes a total of 24 patients with recurrent stricture after ureteroplasty (pyeloplasty 14 patients, ureteroureterostomy 5 patients, ileal flap ureteroplasty 1 patient, buccal mucosa graft ureteroplasty 2 patients, and ureteral bladder replantation 2 patients).…”

“…[20] Furthermore, covered metallic ureteral stent was originally used in treating malignant ureteral strictures, however, it also works well in benign and iatrogenic ureteral strictures, which may be caused by retroperitoneal fibrosis, ureteroscopic lithotripsy, and ureteroileal anastomotic stenosis. [5][6][7]21,22] Nevertheless, whether or not it can be used for the long-term maintenance treatment of recurrent UPJO has not been investigated.…”

“…[4] The placement of the covered metallic ureteral stent results in a good drainage outcome and better quality of life in the maintenance treatment of benign, iatrogenic, and malignant ureteral strictures. [5][6][7] However, there is no relevant research on the outcomes of the covered metallic ureteral stent placement in the long-term maintenance treatment of recurrent UPJO. Therefore, in this study, we analyzed the feasibility of the new segmental-covered metallic ureteral stent for the long-term maintenance treatment of recurrent UPJO after pyeloplasty.…”

Construction of a risk prediction model for ureteral stricture after ureteroscopic holmium laser lithotripsy

“…Long-term incarceration of largediameter stones in the ureter can stimulate mucosal edema and congestion, leading to brous tissue hyperplasia and in ammatory polyps. The above pathological changes will deteriorate under ureteroscopy, thereby contributing to ureteral stenosis [3,13].…”

“…At present, ureteral stenosis is one severe complication after ureteroscopic holmium laser lithotripsy. If the risk of ureteral stenosis can be accurately predicted, the curative effect can be signi cantly better, thus reducing patients' economic burden and cutting medical expenses [3,7,9,11,14] . Hence, this study investigates the risk factors in occurrence of ureteral stricture after ureteroscopic holmium laser lithotripsy, constructs a risk prediction model to provide basis for early clinical identi cation and timely intervention of high-risk cases.…”