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Wu Y, Cao Y, Liu H, Pan X, Wang J, Huang Y, Qi J, Cui X, Zhang L, Ding J. Comparison of Ureteral Stents on Drainage Performance Under Extrinsic Compression. BJU Int 2022; 130:343-349. [PMID: 35137515 DOI: 10.1111/bju.15707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE By investigating deformation and flow velocity of three commonly used, readily accessible ureteral stents under variant compression and surface change at three time points (new, 1 month or 3 months after implantation), we share our center's experience dealing with ureteral obstruction especially the malignant ones. MATERIALS AND METHODS Ureteral double-J (DJ) stents including Cook Universa Soft, Kang Yi Bo (KYB) antireflux and Urovision Visiostar ESWL DJ stents went though scanning microscopic (SEM) analysis. Compression-deformation was measured using digital force gauge. Intraluminal flow velocity was tested with the stents under different compression levels. RESULT Urovision Visiostar demonstrated significantly better anti-compression capability. Cook Universa Soft and KYB antireflux showed favorable draining velocity without compression, but the velocity dropped heavily under compression; the velocity of KYB antireflux reduced heavily after 3 months of implantation; Urovision Visiostar achieved the best draining effect under compression at all three time points. CONCLUSION The Urovision Visiostar DJ stent demonstrated significantly greater resistance to compression than the other two, and better drainage under compression. Patients with benign or malignant ureteral compression might benefit from using the Urovision Visiostar stents. Large prospective clinical trials are needed for confirmation.
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Affiliation(s)
- Yanyuan Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Yiqun Cao
- Department of Operation Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Hailong Liu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Xiuwu Pan
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jie Wang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Yunteng Huang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jun Qi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Xingang Cui
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jie Ding
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
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Kang Q, Jiang F, Yu Y, Yang B. Application of metallic ureteral stents in gynecological malignancies: a literature review. MINIM INVASIV THER 2019; 29:1-9. [PMID: 30793634 DOI: 10.1080/13645706.2019.1572626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ureteral obstruction caused by extrinsic compression from advanced pelvic malignancies are not unusual in urology, with gynecological origin being the most common. As minimally invasive treatments for malignant ureteral obstruction (MUO), metallic ureteral stents have been promoted to provide long-lasting urinary patency and overcome the inherent limits of traditional double-J stents. In this review, we demonstrated three types of frequently used metal stents, including coiled stents, self-expendable stents and thermo-expendable stents. The Wallstent presented discrepant patency rates ranging from 6% to 100%, along with a high occlusion rate. The Memokath 051 stent showed satisfactory patency rates, often > 90%, but also a specific higher migration rate. The Resonance stent provided overall promising results with published success rates ranging from 20% to 100%, which on the whole remains relatively high. The long-term effectiveness rendered metal stents as viable options for managing MUO.
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Affiliation(s)
- Qianyu Kang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Fengze Jiang
- Department of Andrology, Dalian Municipal Women and Children's Medical Center, Dalian, China
| | - Yang Yu
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, China
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The effectiveness of ureteric metal stents in malignant ureteric obstructions: A systematic review. Arab J Urol 2017; 15:280-288. [PMID: 29234529 PMCID: PMC5717459 DOI: 10.1016/j.aju.2017.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/13/2017] [Accepted: 08/20/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To review the literature on the effectiveness, safety and long-term patency of ureteric metal mesh stents (MSs), as a variety of MSs have been used for managing malignant ureteric obstruction over the last three decades. Materials and methods A systematic review using the search string; Ureter∗ AND (stent OR endoprosthesis) AND metal∗ was conducted on PubMed, Scopus, Web of science and Cochrane Library online databases in May 2016. Prospective, retrospective, and comparative studies including MSs were included. The primary endpoint was the patency rate and the secondary endpoint was complications. Results In all, 324 publications were screened and 31 articles were included in the systematic review; 21 prospective and 10 retrospective studies. These studies reported the effectiveness of specific MSs in population studies, in comparative studies among different MSs, as well as among MSs and JJ stents. It should be noted that all comparative studies were retrospective. Conclusion The experiences with vascular MSs, such as the Wallstent™ (Boston Scientific/Microvasive, Natick, MA, USA), were related to high occlusion rates, due to endoluminal hyperplasia, and long-term disappointing patency. The use of covered MSs designed for the vascular system was also unfavourable. The Memokath 051™ (PNN Medical A/S, Kvistgaard, Denmark) had better patency rates, but also higher migration rates. The long-term results were acceptable and rendered the Memokath 051 as a viable option for the management of malignant ureteric obstruction. The Uventa™ (Taewoong Medical, Seoul, Korea) and Allium™ (Allium Medical Solutions Ltd, Caesarea, Israel) MSs, specifically designed for ureteric placement, provided promising results. Nevertheless, the wide acceptance of these MSs would require well-designed clinical studies and long-term follow-up.
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Endoscopic Removal of a Nitinol Mesh Stent from the Ureteropelvic Junction after 15 Years. Case Rep Urol 2015; 2015:273614. [PMID: 26697258 PMCID: PMC4678068 DOI: 10.1155/2015/273614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of a patient with a large stone encrusted on a nitinol mesh stent in the ureteropelvic junction. The stent was inserted in the year 2000 after failure of two pyeloplasty procedures performed due to symptomatic ureteropelvic junction stenosis. By combining minimally invasive urinary stone therapies-extracorporeal shock wave lithotripsy, semirigid ureterorenoscopy with laser lithotripsy, and percutaneous nephrolithotomy-it was possible to completely remove the encrusted stone and nitinol mesh stent that was implanted for 15 years, rendering the patient symptom and obstruction free.
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Proietti S, Sofer M, Giannantoni A, Luciani L, Taverna G, Giusti G. Resonance® metallic stent in patients with ureterocutaneostomies. Int Urol Nephrol 2015; 48:207-12. [DOI: 10.1007/s11255-015-1174-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/25/2015] [Indexed: 11/12/2022]
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Chew BH, Duvdevani M, Denstedt JD. New developments in ureteral stent design, materials and coatings. Expert Rev Med Devices 2014; 3:395-403. [PMID: 16681460 DOI: 10.1586/17434440.3.3.395] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ureteral stents are used in a variety of urological diseases and procedures. The majority of patients with indwelling ureteral stents experience bothersome symptoms and are at increased risk for urinary tract infection. Stent encrustation and the associated complications can also result in significant patient morbidity. The development of new stent designs using novel biomaterials, stent coatings and drug-eluting technologies are being applied to reduce the disadvantageous features of ureteral stents.
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Affiliation(s)
- Ben H Chew
- University of British Columbia, Division of Urology, Vancouver General Hospital, D419 - Heather Pavilion, D-9, 2733 Heather St., Vancouver, BC V5Z 3J5, Canada
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Liatsikos E, Kallidonis P, Stolzenburg JU, Karnabatidis D. Ureteral stents: past, present and future. Expert Rev Med Devices 2014; 6:313-24. [DOI: 10.1586/erd.09.5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ransford G, Pan D, Eldefrawy A, Narayanan G, Manoharan M. Ureterocolic fistula secondary to a self-expanding retrievable ureteral stent. Cent European J Urol 2013; 66:239-41. [PMID: 24579039 PMCID: PMC3936141 DOI: 10.5173/ceju.2013.02.art33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 11/22/2022] Open
Abstract
Self–expanding stents are relatively new in the field of urology and have primarily been used for permanent remodeling of benign or malignant stricture. We are presenting a rare and interesting case of a ureterocolic fistula that formed secondary to placement of an expandable, retrievable metal stent in the ureter. After multiple retrieval efforts, the self–expanding metal stent was finally retrieved and a ureterocolic fistula was appreciated on antegrade pyelography. The patient chose to manage it non–surgically, with routine nephroureteral catheter exchanges, and her creatinine continues to remain stable.
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Affiliation(s)
- George Ransford
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David Pan
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Eldefrawy
- University of Miami Miller School of Medicine, Miami, FL, USA
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Lang EK, Winer AG, Abbey-Mensah G, Anne R, Allaei A, Friedman F, Thomas R, La Nasa J, Davis R. Long-term results of metallic stents for malignant ureteral obstruction in advanced cervical carcinoma. J Endourol 2013. [PMID: 23199302 DOI: 10.1089/end.2012.0552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We present our experience with the use of metallic stents (Wallstents®) in the management of malignant ureteral obstruction to maintain renal function, thereby permitting the use of chemotherapeutic agents to treat the underlying malignancy. PATIENTS AND METHODS We retrospectively reviewed the records of 24 patients with ureteral obstruction secondary to advanced cervical carcinoma, stage T3b (n=10) and T4 (n=14), that was relieved by Wallstents. Nineteen patients needed bilateral and 5 needed unilateral Wallstents to relieve the obstruction. Fifty-six additional endourologic interventions were necessary to assure continued patency. Holmium laser ablation was used 14 times to manage tumor proliferation and ingrowth at the distal end of the stent. Thirty-two endostents, 4 extension, and 6 replacement stents were used to maintain patency of the ureter. RESULTS Nineteen of our 24 patients received between one and five chemotherapeutic cycles over 18 to 140 months. In five patients, placement of Wallstents did not achieve adequate decrease of the creatinine levels to allow treatment with chemotherapy. Thirteen of 24 Wallstents remained patent over 18 months, yielding a primary patency rate of 54%. Technical success rate of Wallstent placement was 100%. The overall mean primary and secondary patency rates of the stent were 16.5 and 52 months, respectively. For T3b and T4 patients, the mean primary patency rates were 20.6 and 13.6 months, respectively. Secondary patency for T3b patients was 73.9 months vs 36.4 months for T4 patients. There were no serious complications associated with Wallstent placement. CONCLUSION Wallstents offer a salutary solution to the problem of maintaining prolonged patency of ureters compromised by encasing neoplasms.
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Affiliation(s)
- Erich K Lang
- Departments of Urology and Radiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
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Abstract
Ureteral metal stents (MSs) present a minimally invasive tool to preserve the drainage of renal pelvis whenever ureteral patency is at risk to be obstructed due to extrinsic or intrinsic etiologies. Clinical experience with these stents demonstrates that they impose a promising alternative treatment option in ureteral pathologies that are difficult to be treated via common polymeric stents. Current application of MSs in the treatment of both benign and malignant ureteral obstruction reveals quite promising results. Nevertheless, the ideal MS that would provide uncomplicated long-term effectiveness is still lucking and current MS usage is facing several adverse effects between which stent obstruction, encrustation, infection, migration, and patient discomfort. Ongoing attempts to create more inert stent with sophisticated novel designs are expected to improve current MS efficiency. MSs will play a major role in the future as a routine management of a variety of ureteral pathologies.
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Sountoulides P. Are metal ureteral stents indicated in cases of benign upper urinary tract obstruction? Indian J Urol 2011; 27:305-6. [PMID: 22022050 PMCID: PMC3193727 DOI: 10.4103/0970-1591.85419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sountoulides P, Kaplan A, Kaufmann OG, Sofikitis N. Current status of metal stents for managing malignant ureteric obstruction. BJU Int 2010; 105:1066-72. [DOI: 10.1111/j.1464-410x.2009.09140.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Burgos FJ, Bueno G, Gonzalez R, Vazquez JJ, Diez-Nicolás V, Marcen R, Fernández A, Pascual J. Endourologic implants to treat complex ureteral stenosis after kidney transplantation. Transplant Proc 2010; 41:2427-9. [PMID: 19715941 DOI: 10.1016/j.transproceed.2009.06.068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of nitinol stents and the Detour extra-anatomical ureteral bypass graft in treatment of ureteral stenosis after kidney transplantation. PATIENTS AND METHODS Eighteen kidney transplant recipients with complex stenosis caused by failure of primary treatment or with high surgical risk or a poorly functioning graft (serum creatinine concentration >2.5 mg/dL) were treated using antegrade percutaneous implantation of nitinol stents (n = 16) or extra-anatomical ureteral bypass grafts (n = 3); 1 patient was treated with both techniques. RESULTS Mean (range) follow-up of ureteral stents was 51.2 (3-118) months. Patency rate at last follow-up, resumption of dialysis therapy, or death was 75% (12 of 16 patients). In 4 patients (25%), stent occlusion developed, which was treated using a double-J catheter in 2 patients, stent removal and pyeloureterostomy using the native ureter in 1 patient, and implantation of an extra-anatomical bypass graft in 1 patient. Mean follow-up in patients with extra-anatomical ureteral bypass grafts was 32 (8-64) months. One patient developed a urinary tract infection, and another had encrustation with obstruction. CONCLUSIONS Use of nitinol ureteral stents and extra-anatomical ureteral bypass grafts is a safe and effective alternative to surgery for treatment of post-kidney transplantation ureteral stenosis in patients with chronic graft dysfunction, those at high surgical risk, and those in whom previous surgical treatment has failed.
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
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Liatsikos EN, Kallidonis P, Kyriazis I, Karnabatidis D, Tsamandas A, Sakellaropoulos G, Flaris N, Rigopoulos C, Toronidis C, Efthimiou I, Filos K, Siablis D, Perimenis P. Metallic double pigtail ureteral stent usage during extracorporeal shock wave lithotripsy in the swine model: is there any effect on the ureter? J Endourol 2009; 23:685-91. [PMID: 19335328 DOI: 10.1089/end.2008.0569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To examine the safety and compatibility of full-length metal ureteral stent usage with extracorporeal shock wave lithotripsy (SWL). METHODS Four Resonance ureteral stents and four special Resonance ureteral stents modified to contain thermocouples were placed unilaterally in eight pigs, with contralateral ureter of each pig serving as its own control. All pigs were subjected to the same SWL protocol in both their ureters. In the animals containing the modified stents, ureter temperature was monitored during treatment. The animals were sacrificed on days 1 and 15 after treatment, and both their ureters were histologically examined. RESULTS No statistically significant increase (mean increase of 0.5 degrees C, p > 0.05) of stent temperature was observed during treatment. No differences in histology were observed among ureters containing stents and control ureters at both days 1 and 15 after treatment. CONCLUSION SWL appears to be harmless for the ipsilateral ureter.
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Liatsikos E, Kyriazis I, Kallidonis P, Tsamandas A, Karnabatidis D, Sakellaropoulos G, Flaris N, Kalogeropoulou C, Filos K, Stolzenburg JU, Kardamakis D. Ureteric response to abdominal radiotherapy and metallic double-pigtail ureteric stents: a pig model. BJU Int 2009; 104:862-6. [PMID: 19389017 DOI: 10.1111/j.1464-410x.2009.08507.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the safety and compatibility of full-length metal ureteric stents with abdominal radiotherapy. MATERIALS AND METHODS Four ureteric stents (Resonance(TM), Cook Urological, Ireland) (RS) and four RSs specially modified to contain thermocouples were placed unilaterally in eight pigs. The contralateral ureters of the same pigs served as their controls, and contained two polymeric ureteric catheters and two similar specially modified to contain thermocouples, while the remaining four control ureters remained intact. All pigs were exposed to abdominal radiotherapy. The dose rate was approximately 5.3 Gy/min and a total radiation dose of 10 Gy was administered. Throughout the treatment the temperature was monitored by the RSs and catheters containing the thermocouples. The pigs were killed at 1 day (four), 7 days (two) and 15 days (two) after treatment, and all ureters examined histologically. RESULTS There was no statistically significant increase in RS and catheter temperature throughout the treatment in any of the treated pigs (P > 0.05). All histological lesions reported were due to radiation treatment. There were no differences in histology between the ureters containing RSs and controls. CONCLUSION RS usage is unrelated to any increase in stent temperature during abdominal radiotherapy and does not cause any further deterioration in the histology of the ipsilateral ureter, additional to that caused by the initial treatment.
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Liatsikos EN, Karnabatidis D, Katsanos K, Kallidonis P, Constantinides C, Perimenis P, Stolzenburg JU, Siablis D. Rebuttal. J Endourol 2008. [DOI: 10.1089/end.2008.9736a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Liatsikos EN, Karnabatidis D, Katsanos K, Kallidonis P, Constantinides C, Perimenis P, Stolzenburg JU, Siablis D. Metal Stents for the Management of Malignant Ureteral Obstruction. J Endourol 2008; 22:2099-100; discussion 2107. [DOI: 10.1089/end.2008.9736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - Petros Perimenis
- Department of Urology, University of Patras, School of Medicine, Patras, Greece
| | | | - Dimitrios Siablis
- Department of Radiology, University of Patras, School of Medicine, Patras, Greece
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Nagele U, Kuczyk MA, Horstmann M, Hennenlotter J, Sievert KD, Schilling D, Walcher U, Stenzl A, Anastasiadis AG. Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis. World J Urol 2008; 26:257-62. [PMID: 18324407 DOI: 10.1007/s00345-008-0245-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 02/13/2008] [Indexed: 12/12/2022] Open
Affiliation(s)
- Udo Nagele
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Rashid T, Foley CL, Briggs TP. Re: Borin JF, Melamud O, Clayman RV. Initial Experience with Full-Length Metal Stent to Relieve Malignant Ureteral Obstruction. J Endourol 2006;20:300–304. J Endourol 2008; 22:393. [PMID: 17705774 DOI: 10.1089/end.2007.0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Li X, He Z, Yuan J, Zeng G, He Y, Lei M. Long-term results of permanent metallic stent implantation in the treatment of benign upper urinary tract occlusion. Int J Urol 2007; 14:693-8. [PMID: 17681057 DOI: 10.1111/j.1442-2042.2007.01802.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The management of complicated benign upper urinary tract occlusion is extremely challenging, especially in patients unable to undergo an open operative procedure. We report the long-term results of a permanent metallic stent for benign upper urinary tract occlusion. METHODS From October 1995 to December 1998, 13 patients (8 men and 5 women, with a mean age of 43 years) with benign upper tract occlusion have been treated by metallic stent implantation. All patients had a nephrostomy tube to relieve the obstruction and the average time of the nephrostomy tube stay was 27 months, ranging from 3 to 131 months. The average length of occlusion was 2.7 cm, ranging from 1 to 3.6 cm. Ultrasonography, urography, diuresis renography and urine culture were performed every 3 months after stent insertion. Ureteroscopy was done when needed. RESULTS The mean follow-up was 92 months (12-132 months). Ureteral patency was achieved in six patients and assisted patency with a Double-J stent was achieved in three patients. In two patients the kidney had to be removed because of progressive malfunction and in two patients the metal stent had to be extracted with the Holmium: YAG laser, burning it down due to the uncontrollable pyonephrosis. In three patients the ipsilateral flank pain recurred. One of these patients experienced urine leakage due to the initial nephrostomy tract: a ureteroscopy revealed a complete hyperplastic urothelial response. Proximal stone formations were found in 2 patients and all were removed by percutaneous nephrolithotomy (PCNL). No stent migration or fragmentation was observed. CONCLUSION The implantation of metal stent is a safe and effective treatment for benign upper urinary tract occlusion, and has satisfying long-term outcome in selected cases. A further investigation is needed for its impact on the urodynamics of upper urinary tract.
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Affiliation(s)
- Xun Li
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
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Liatsikos EN, Karnabatidis D, Kagadis GC, Rokkas K, Constantinides C, Christeas N, Flaris N, Voudoukis T, Scopa CD, Perimenis P, Filos KS, Nikiforidis GC, Stolzenburg JU, Siablis D. Application of Paclitaxel-Eluting Metal Mesh Stents within the Pig Ureter: An Experimental Study. Eur Urol 2007; 51:217-23. [PMID: 16814926 DOI: 10.1016/j.eururo.2006.05.054] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of the present study is to compare the standard bare metal stents (BMS) with the Paclitaxel-Drug Eluting Stent (DES) in the ureter of a pig model. MATERIALS AND METHODS We report on an experimental study with ten female pigs weighing between 25 and 30 kg. The stents were randomly placed in either the right or left ureter in each of 10 study animals, for a total of 20 stented ureters. Ten ureters were stented with an R-Stent (Orbus Medical Technologies, Hoevelaken Netherlands), and ten with a Paclitaxel-Eluting Coronary Stent (Boston Scientific, Natick, MA, USA). Patency was measured by radiograph of the nephrostomy tract, intravenous urography and virtual endoscopy at 24 hours and 21 days after the initial procedure, respectively. RESULTS Free flow of urine through the stents into the bladder was documented in all stented ureters 24 hours after stent insertion by radiograph of the nephrostomy tract. At the 21 day follow-up examination, 5 R-Stents were found to be completely occluded and two partially stenosed, whereas no occluded stent was detected in the Paclitaxel-DES group. Pathology examination of the stents at 21 days follow-up showed that the obstructed R-Stents generated severe inflammation with metaplasia of the urothelium. The Paclitaxel-Eluting MS generated a mild inflammatory response within the ureteral lumen at the site of the stent, without hindering ureteral patency. R-stents proved to develop more hyperplasia compared to the Paclitaxel-Eluting MS. CONCLUSIONS Paclitaxel-DES, when compared with the standard R- Stent BMS, generated less inflammation and/or hyperplasia of the surrounding tissues, thus maintaining ureteral patency. Long-term animal trials are required to further validate our results.
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Chew BH, Denstedt JD. Technology insight: Novel ureteral stent materials and designs. ACTA ACUST UNITED AC 2006; 1:44-8. [PMID: 16474466 DOI: 10.1038/ncpuro0014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 09/18/2004] [Indexed: 11/09/2022]
Abstract
Ureteral stents are an important tool for aiding upper urinary tract drainage, but can cause significant patient morbidity. Common problems include stent-induced pain, hematuria, dysuria, infection, and encrustation. From a urologist's perspective, stents must be easy to maneuver in the urinary tract, radiopaque, and affordable. Since the development of the modern day stent in 1978, stents have evolved to include softer biomaterials that are more resistant to encrustation and infection. An ideal biomaterial is one that is not affected by its environment and does not elicit reactive changes in surrounding tissues. To date, the ideal biomaterial or stent does not exist. This review discusses developments that address the issues of infection, biofilm formation, encrustation, and patient comfort. Stent materials including polyurethane, silicone, biodegradable substances and new combination polymers are reviewed, in addition to novel stent coatings such as heparin, hydrogel, and silver nitrate. Ureteral stent technologies currently lag behind vascular stents, particularly drug-eluting stents, but new developments will continue to improve these essential urological tools.
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Affiliation(s)
- Ben H Chew
- University of Western Ontario, London, Ontario, Canada
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Hendlin K, Vedula K, Horn C, Monga M. In vitro evaluation of ureteral stent compression. Urology 2006; 67:679-82. [PMID: 16600353 DOI: 10.1016/j.urology.2005.10.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 09/21/2005] [Accepted: 10/19/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the force required to radially compress ureteral stents and the impact of compression on stent performance across a broad range of stent sizes and manufacturers. METHODS Fourteen ureteral stents ranging in size from 6F to 10.3F were evaluated for radial compression using an MTS Micro Bionix Testing System using Testworks II software, 5N load cell, vibration isolation table, and socket set screws with rounded caps. Radial compression was exerted in 0.2-mm increments. Cycles of compression and a 100-second hold time were repeated for each stent to maximal compression. Three trials were completed for each stent. The Young's Modulus, E, was calculated from each trial using the engineering stress. Simultaneous flow data using normal saline were collected for the Amplatz stent. RESULTS The Cook C-Flex (E = 30,355 +/- 910 Pa), Microvasive Percuflex Plus 6F (E = 28,973 +/- 250 Pa), Cook EndoSof (E = 28,403 +/- 471 Pa), and Fossa Open Lumen (E = 28,627 +/- 5,338) were the most resistant to compression and the Cook Amplatz 10.2F (E = 11,922 +/- 220 Pa) and Microvasive Percuflex Plus 10.3F (E = 8,247 +/- 286 Pa) were the least resistant to compression. Stress relaxation occurred similarly in all stents. Flow through the Cook Amplatz stent decreased at a rate of 5 mL/s/mm of compression linearly (R2 = 0.95). CONCLUSIONS Stents resistant to radial compression are critical for function in the face of extrinsic ureteral obstruction. The Cook C-Flex ureteral stent resisted extrinsic compressive forces best. Although large-lumen stents are often used in this clinical situation, they were the most susceptible to compressive forces.
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Affiliation(s)
- Kari Hendlin
- Department of Urologic Surgery, Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
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Burgos FJ, Pascual J, Marcen R, García-Navas R, García IG, Alarcón C, Gómez V, García-Ortells D, Tabernero G, Ortuño J. Self-Expanding Metallic Ureteral Stents for Treatment of Ureteral Stenosis After Kidney Transplantation. Transplant Proc 2005; 37:3828-9. [PMID: 16386553 DOI: 10.1016/j.transproceed.2005.09.198] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of post-renal transplantation ureteral stenosis ranges from 2%-12%. Because the role of self-expanding ureteral metallic stents for its treatment has been scarcely reported, the aim of this study was to evaluate the efficacy of Nitinol stents. Eleven ureteral stenoses in patients with chronic graft dysfunction (8 cases) or high surgical risk (3 cases) were treated by antegrade percutaneous implantation of Nitinol stents through a nephrostomy tract. The mean follow-up period was 48 +/- 7 months (range, 3-85 months). The patency rate at the moment of return to dialysis, death, or last check-up was 73% (8/11). Three patients (27%) developed stent occlusion. Two patients were treated using a trans-stent double-J catheter and 1 patient using stent removal and pyeloureterostomy using the native ureter. The mean percentage decrease in serum creatinine (Cr) level after stent implantation was 41% (range, 14%-63%). Nitinol ureteral stent implantation is an effective alternative for the treatment of ureteral stenosis in patients with chronic graft dysfunction or high surgical risk.
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
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Abstract
There are four types of ureteral metal stents: self expandable, balloon expandable, covered, and thermoexpandable shape-memory. Insertion of metal stents requires expertise with transurethral and percutaneous techniques. The stricture is traversed with the aid of a guidewire via a percutaneous nephrostomy, and the stenotic segment is dilated using a high-pressure balloon catheter. The stent is then inserted over the guidewire, such that the upper end bypasses the obstruction by at least 3 to 4 cm, while the lower end extends intravesically for 0.5 to 1 cm from the ureteral orifice. If necessary, two or more stents are placed in sequence, overlapping by at least 2 to 3 cm. Metal stents were initially used for the relief of end-stage malignant disease, and their role in the treatment of benign ureteral strictures is still undefined. Patients often complain of abdominal discomfort and mild pain after stent insertion, which soon resolve spontaneously. Hematuria usually stops after a few days and does not necessitate any treatment. Mild urothelial hyperplasia in the stent lumen is common but usually regresses after 4 to 6 weeks. Many authors suggest the use of a double-pigtail catheter for the first 4 to 6 weeks to avoid narrowing of the ureteral lumen. The influence of stents on ureteral peristalsis is a major but poorly documented issue. Encrustation is a significant problem that needs to be addressed. The characteristics of both the patient and the stent influence its likelihood. Migration of coated metal stents was seen in 81% of patients at our center. Virtual endoscopy has recently been introduced as a tool for the follow-up of patients with stented ureters. Further design development is necessary to obtain the ideal ureteral metal stent. In a recent study in female pigs, paclitaxel-eluting metal stents engendered less inflammation and hyperplasia of the surrounding tissues.
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Soria F, Sun F, Durán E, Sánchez FM, Usón J. Metallic Ureteral Stents versus Endoureterotomy as a Therapeutic Approach for Experimental Ureteral Stricture. J Vasc Interv Radiol 2005; 16:521-9. [PMID: 15802452 DOI: 10.1097/01.rvi.0000147074.74604.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine if the deployment of metallic ureteral stents in benign ureteral stricture is more effective than endoureterotomy. MATERIALS AND METHODS Twenty pigs were randomly divided in two groups to be treated with endoureterotomy or metallic stents. The internal ureteral diameter 2 cm distal to the ureteropelvic junction, histopathologic changes, ultrasonographic and fluoroscopic studies, urine culture, and serum urea and creatinine levels were analyzed during the phases of the study. The study was divided into three phases. The first included premodel documentation of normal urinary tract and laparoscopic ureteral stricture induction. In the second phase 1 month later, diagnosis and endoureteral treatment were carried out. Twelve weeks after stricture treatment, follow-up imaging studies and postmortem evaluation of all animals were performed. RESULTS The success rates were 80% for endoureterotomy and 70% for metallic stent implantation. In all animals in the latter group, a ureteral hyperplasic reaction took place that affected the zone of stent implantation. One difference between the groups was the presence of urinary infection in 30% of animals in the endoureterotomy group and in no animals treated with metallic stents. Statistically significant differences in ureteral diameter between the first and second study phases were found within both groups (P < .0001), but not between groups (P = .021). Results from pathologic analysis revealed statistically significant differences between groups (P = .0029). CONCLUSIONS The interaction among the distal end of the metallic stent, the urothelium, and peristalsis might be the origin of the failure of these devices. Although the deployment of metallic stents is attractive compared with other endourologic techniques like endoureterotomy in cases of benign strictures, certain problems must be resolved to prevent hyperplasia. Until then, this technique will not be a fully reliable therapeutic option for ureteral disorders.
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Affiliation(s)
- Federico Soria
- Endoscopy Department, College of Veterinary Medicine, University of Extremadura, Cáceres, Spain.
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Balakrishnan N, Uvelius B, Zaszczurynski P, Lin DL, Damaser MS. BIOCOMPATIBILITY OF NITINOL AND STAINLESS STEEL IN THE BLADDER: AN EXPERIMENTAL STUDY. J Urol 2005; 173:647-50. [PMID: 15643281 DOI: 10.1097/01.ju.0000143197.93944.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We tested the biocompatibility of nitinol, a nickel titanium alloy, and stainless steel (SS) as bladder implant materials. MATERIALS AND METHODS Rats received a nitinol implant, an SS implant or were sham controls. Two, 3, 6 and 8 weeks following implantation 24-hour voiding behavior studies were performed to investigate bladder irritation. All animals were sacrificed 8 weeks after implantation and a sample of urine was aspirated for culture. The bladders were examined by light microscopy and scanning electron microscopy (SEM). RESULTS No visible encrustations or infections were noted in urine. Voiding frequency in the light period 6 weeks after implantation was significantly decreased in the 2 implant groups compared with sham controls. There were no other significant differences in frequency or mean volume per void in the light or dark periods at any time point. Light microscopy demonstrated similar implant tissue effects in all groups with little or no inflammation or fibrosis. Under SEM all implants showed a brittle, amorphous coating devoid of cells. The transition between the urothelium mucosa and the rod was smoother for SS than for nitinol, suggesting an affinity of SS for mucosa. In all nitinol rods discontinuity was present between the mucosa and rod. CONCLUSIONS Nitinol and SS do not cause more irritation than the effects of surgery alone and the 2 materials seem to be biocompatible in the bladder. Nitinol may be more inert than SS based on SEM results.
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Chung SY, Stein RJ, Landsittel D, Davies BJ, Cuellar DC, Hrebinko RL, Tarin T, Averch TD. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol 2004; 172:592-5. [PMID: 15247739 DOI: 10.1097/01.ju.0000130510.28768.f5] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We assessed the success of retrograde placement of indwelling ureteral stents in the management of ureteral obstruction due to extrinsic compression. MATERIALS AND METHODS Between July 1987 and December 2002 adequate followup was available for 101 patients who underwent primary retrograde ureteral stenting for extrinsic ureteral obstruction. Mean age at presentation was 61.4 years (range 33 to 90). Chart review was performed on all patients for primary diagnosis, symptomatology, degree of hydronephrosis, creatinine levels (baseline, treatment and posttreatment), location of compression, size and number of stents used, progression to percutaneous nephrostomy tube (PNT), stent failure, days to stent failure, post-stent therapy and status at last followup. RESULTS Mean length of followup was 11 months (range 1 to 127). In 101 patients 138 ureteral units (UU) were stented. Total stent failure occurred in 41 (40.6%) patients and 58 (42.0%) UU. A total of 40 (29.0%) UU required PNTs at a mean of 40.3 days (range 0 to 330) with 18 PNTs placed in less than 1 week. Cases of stent failure that did not undergo PNT placement included 18 (13.0%) UU at a mean of 52.4 days (range 3 to 128). A total of 90 (89.1%) patients had metastatic cancer at stenting with 32.2% dead at 5.8 months (range 1 to 32). Univariate and multivariate analyses identified cancer diagnosis, baseline creatinine greater than 1.3 mg/dl and post-stent systemic treatment as predictors of stent failure. Proximal location of compression and treatment creatinine greater than 3.11 mg/dl were marginal predictors of failure on univariate analysis, while proximal location of obstruction was also marginally significant on multivariate analysis. No predictors were identified for early stent failure (less than 1 week). CONCLUSIONS At almost 1 year followup stent failure due to extrinsic compression occurred in nearly half of treated patients. Analysis of data revealed a diagnosis of cancer, baseline mild renal insufficiency and metastatic disease requiring chemotherapy or radiation as predictors of stent failure. Managing extrinsic compression by retrograde stenting continues to be a practical but guarded decision and should be tailored to each patient.
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Affiliation(s)
- Steve Y Chung
- Department of Urology, University of Pittsburgh Medical Center, Pennsylvania, USA.
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Abstract
PURPOSE To review the role of minimally invasive management in ureteral stricture disease. MATERIALS AND METHODS A literature search was performed on the MEDLINE database through 2002 concerning endoscopic treatment of patients with ureteral strictures. RESULTS Many endourologic methods are available for ureteral strictures. Ureteral dilation may be accomplished in most cases, with various rates of success depending on stricture etiology, location, and length. Endoureterotomy also leads to long-term patency in properly selected cases and appears to be superior to dilation alone. CONCLUSIONS Significant advances in technique and technology have improved our ability to treat ureteral strictures without the need for open surgery in most patients.
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Affiliation(s)
- Khaled S Hafez
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Nishino S, Goya N, Ishikawa N, Tomizawa Y, Toma H. An experimental study of self-expanding ureteric metallic stents: macroscopic and microscopic changes in the canine ureter. BJU Int 2002; 90:730-5. [PMID: 12410757 DOI: 10.1046/j.1464-410x.2002.02995.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of self-expanding metallic stents after insertion into the canine ureter. MATERIALS AND METHODS Actively expanding metallic (Nitinol) stents (diameter 8-10 mm, length 4-6 cm) were placed in eight mongrel dogs (18-34 kg). Under general anaesthesia, a midline abdominal incision was made and a stent inserted directly into the ureter through a small incision; each animal was stented on one side. The dogs were assessed after 6 or 19 days or 2, 5 (two), 6 (two) and 7 months. Ureteric specimens were evaluated both macroscopically and microscopically. RESULTS Macroscopically there was no leakage of urine in any of the animals. On day 6 the inserted stent was patent despite blood clots in the mesh. The lumen was smooth and shiny in three dogs examined at 5, 6 and 7 months. One of the two dogs assessed at both 5 and 6 months had hydronephrosis associated with papillary hyper-epithelialization inside the stent, while the other animals had no dilatation of the renal pelvis. Microscopically there was loss of epithelium and bleeding of the ureteric wall at 6 days. Epithelial regeneration started after 19 days and was complete in the lumen at 2 months, with the stent incorporated into the wall of the ureter. Epithelialization was maintained up to 7 months, after which the problem of urothelial hyperplasia persisted, but an adequate lumen was maintained by epithelial regeneration. This epithelium was smooth and shiny, and composed of thin layers of cells. CONCLUSION Self-expanding metallic stents may be effective if hyperplastic epithelialization does not occur, as the stent was epithelialized within 2 months and the regenerated epithelium maintained for up to 7 months. Metallic stents may be useful for treating patients with renal failure caused by ureteric stenosis from malignant tumours.
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Affiliation(s)
- S Nishino
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Park DS, Park JH, Lee YT. Percutaneous nephrostomy versus indwelling ureteral stents in patients with bilateral nongenitourinary malignant extrinsic obstruction. J Endourol 2002; 16:153-4. [PMID: 12028623 DOI: 10.1089/089277902753716106] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
We present five cases of bilateral extrinsic ureteral obstruction in advanced nongenitourinary abdominal malignancy. They show the superiority of percutaneous nephrostomy to indwelling ureteral stents in providing diversion. We suggest that percutaneous nephrostomy drainage should be the management of choice in extrinsic obstruction by advanced abdominal malignancies.
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Affiliation(s)
- Dong Soo Park
- Department of Urology, Pundang CHA General Hospital, Pochon CHA University College of Medicine, Sungnam, Korea.
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Rotariu P, Yohannes P, Alexianu M, Rosner D, Lee BR, Lucan M, Smith AD. Management of malignant extrinsic compression of the ureter by simultaneous placement of two ipsilateral ureteral stents. J Endourol 2001; 15:979-83. [PMID: 11789979 DOI: 10.1089/089277901317203047] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Extrinsic ureteral obstruction caused by various malignancies often necessitates urinary diversion. The use of single ureteral stents as a form of urinary diversion results in a high failure rate, while the use of two ipsilateral stents has shown promising results. We report our experience using the latter technique. PATIENTS AND METHODS Between 1996 and 2001, four male and three female patients with a mean age of 65 years (range 37-95 years) who had extrinsic compression of the ureters underwent single stent management to relieve obstruction. Ureteral obstruction was secondary to prostate cancer (N = 3), cervical cancer (2), non-Hodgkin's lymphoma (1), and transitional-cell cancer of the bladder and ureter (1). After failure of such management, two 7F stents or a combination of 8F/6F double-J ureteral stents were placed. The stents were changed every 4 to 6 months. Follow-up included serial renal ultrasound scans and serum creatinine measurements. RESULTS Ureteral stricture length ranged from 2 to 4 cm. Insertion of two double-J ureteral stents in a single ureter was successful in all cases. During the mean follow-up of 16 months (range 1-38 months), the ureteral stents were tolerated by all patients, without significant discomfort. Marked improvement of hydronephrosis and alleviation of flank pain was noted in all patients. Three patients have died at 1 to 3 months. Renal function improved, with a mean decline in the serum creatinine concentration from 3.2 mg/dL to 1.48 mg/dL in the five patients tested. CONCLUSION Simultaneous placement of two double-J ureteral stents for the management of ureteral obstruction secondary to a malignancy is a safe and effective technique.
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Affiliation(s)
- P Rotariu
- Department of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center Campus, New Hyde Park, New York, USA
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Tekin MI, Aytekin C, Aygün C, PeSkircioğlu L, Boyvat F, Ozkardeş H. Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results. Urology 2001; 58:919-23. [PMID: 11744459 DOI: 10.1016/s0090-4295(01)01414-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.
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Affiliation(s)
- M I Tekin
- Department of Urology, Başkent University School of Medicine, Ankara, Turkey
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KULKARNI RAVI, BELLAMY ELIZABETH. NICKEL-TITANIUM SHAPE MEMORY ALLOY MEMOKATH 051 URETERAL STENT FOR MANAGING LONG-TERM URETERAL OBSTRUCTION: 4-YEAR EXPERIENCE. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65667-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- RAVI KULKARNI
- From the Departments of Urology and Radiology, Ashford and St. Peter’s Hospital, Ashford, Middlesex, United Kingdom
| | - ELIZABETH BELLAMY
- From the Departments of Urology and Radiology, Ashford and St. Peter’s Hospital, Ashford, Middlesex, United Kingdom
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NICKEL-TITANIUM SHAPE MEMORY ALLOY MEMOKATH 051 URETERAL STENT FOR MANAGING LONG-TERM URETERAL OBSTRUCTION. J Urol 2001. [DOI: 10.1097/00005392-200111000-00030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liatsikos EN, Siablis D, Kalogeropoulou C, Karnabatidis D, Triadopoulos A, Varaki L, Zabakis P, Perimenis P, Barbalias GA. Coated v noncoated ureteral metal stents: an experimental model. J Endourol 2001; 15:747-51. [PMID: 11697409 DOI: 10.1089/08927790152596361] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of the present study was to compare the standard metal stents with internally and externally coated metal stents in the pig model. MATERIALS AND METHODS In nine female pigs weighing between 25 and 30 kg, the metal stents were randomly placed in either the right or left ureter, for a total of 18 stented ureters. Six ureters were stented with a Wallstent (Schneider, Zurich, Switzerland), six with a Passager stent (Boston Scientific, Natick, MA, USA), and six with a Corvita endoluminal graft (CEG) (Boston Scientific, Natick, MA, USA). Patency was examined by nephrostotomography 24 hours and 21 days after the initial procedure. RESULTS Free flow of urine through the stents into the bladder was revealed in all ureters with the exemption of four cases where a Passager stent migrated into the bladder, jeopardizing ureteral patency. The Wallstent generated mild inflammation with metaplasia of the urothelium; the CEG a more pronounced inflammatory response in the adjacent ureter; and the Passager stent severe inflammatory reaction with necrosis of the urothelium. The sections of the Wallstents revealed the presence of a mild polypoid reaction adherent to the internal surface of the devices. The coated stents showed no tissue ingrowth through the lining material into the ureteral lumen, and thus, the urothelium was compressed beneath the prostheses. CONCLUSIONS Our experimental results suggest that the standard Wallstent generates less inflammation of the surrounding tissues than coated stents. The coated stents have the advantage of minimal tissue ingrowth but have a tendency to migrate toward the bladder.
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Affiliation(s)
- E N Liatsikos
- Department of Urology, University of Patras, School of Medicine, Greece
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Antimisiaris SG, Siablis D, Liatsikos E, Kalogeropoulou C, Tsota I, Tsotas V, Karnabatidis D, Fatouros DG, Barbalias GA. Liposome-coated metal stents: an in vitro evaluation of controlled-release modality in the ureter. J Endourol 2000; 14:743-7. [PMID: 11110569 DOI: 10.1089/end.2000.14.743] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE In vitro preparation of liposome-covered metal stents and loading of liposomal drug formulations that will slowly release the drug in the vicinity of the stent. MATERIALS AND METHODS Polytetrafluoroethylene-coated stents were used. Large multilamellar (MLV) liposomes (phosphatidylcholine:cholesterol 1:1 mol/mol), empty or entrapping the corticosteroid anti-inflammatory drug, dexamethasone, were prepared by the thin-film hydration method and applied to pieces of stent using a simple and mild evaporation technique. Initially, a freeze-drying method for applying liposomes to stents was also evaluated, but it failed to produce stents that efficiently retain liposomal lipid when incubated in an aqueous environment. The presence of liposomes on the stent surface was confirmed by scanning electron microscopy. RESULTS After analyzing the release of liposomal lipid (using a phospholipid assay) and liposomal drug (by a modified dexamethasone high-pressure liquid chromatography method) in an in vitro system developed to simulate in vivo conditions, it was found that 39.11+/-6.8% of the lipid and 50.84+/-5.48% of the drug was released from the stent pieces during 48 hours of incubation in the presence of artificial urine. The amount of dexamethasone released from stents during their application procedure was found to be negligible in an in vitro dry run. CONCLUSION The use of stent-associated liposomal drug formulations as slow-release depots could be an efficient method of treating the untoward event of ureteral stent obstruction.
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Affiliation(s)
- S G Antimisiaris
- Department of Urology, University of Patras, School of Medicine, Greece
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40
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Affiliation(s)
- D Tolley
- The Scottish Lithotriptor Centre, Department of Urology, Western General Hospital, Edinburgh, UK
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41
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Richter F, Irwin RJ, Watson RA, Lang EK. Endourologic management of malignant ureteral strictures. J Endourol 2000; 14:583-7. [PMID: 11030541 DOI: 10.1089/08927790050152195] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This retrospective analysis assessed the efficacy of balloon dilatation, endoureterotomy, percutaneous ureteroneocystostomy with stenting, and insertion of Wallstents in the management of malignant ureteral strictures with an intact or compromised vascular supply. PATIENTS AND METHODS A series of 127 patients with ureteral strictures secondary to malignancies were assessed after at least 2-year follow-up (range 2-5 years; mean 3.5 years). Balloon dilation (antegrade approach) was applied in 46 patients, endoureterotomy with temporary stenting in 37, percutaneous ureteroneocystostomy with stenting in 34, bougie and stents in 13, and Wallstents in 31. RESULTS Balloon dilatation was successful in only two of four malignant midureteral stenoses with intact vascular supplies and was even less successful (10%) in midureteral strictures with a compromised vascular supply. Endoureterotomy failed in all cases to prevent ureteral obstruction. Percutaneous ureteroneocystostomy achieved patency in 11 of 34 patients (33%) having a compromised ureteral vascular supply. Wallstents were successful in 18 of 31 patients (58%) with stenoses of the pelvic ureter. CONCLUSIONS Percutaneous ureteroneocystostomy with stenting meets the requirement for palliation in patients with obstruction secondary to pelvic neoplasms. Wallstents proved to be most successful when used in the pelvic ureter.
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Affiliation(s)
- F Richter
- Section of Urology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark 07103-2714, USA.
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Feng MI, Bellman GC, Shapiro CE. Management of ureteral obstruction secondary to pelvic malignancies. J Endourol 1999; 13:521-4. [PMID: 10569528 DOI: 10.1089/end.1999.13.521] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the efficacy of urinary diversion (internal v external) in the management of ureteral obstruction secondary to pelvic malignancies and the patients' quality of life after diversion. PATIENTS AND METHODS Thirty-seven patients presented with malignant ureteral obstruction secondary to primary neoplasms of the pelvis or metastatic disease of the pelvis and retroperitoneum and underwent urinary diversion. Patients were categorized into two groups according to the success (Group I) or failure (Group II) of internal stent drainage. Successful drainage was defined according to either radiologic study or the serum creatinine concentration in the case of a solitary kidney. "Useful life" was defined as satisfying four criteria: (1) little or no pain; (2) no complications; (3) ability to return home for at least 2 months; and (4) full mental capacity. RESULTS Of the total patient population, 58% ultimately failed internal diversion. Nearly all (92%) of the cervical cancer patients required external drainage. Complications were seen in 10% of the stented patients and 13% of the patients with a percutaneous nephrostomy tube, but no procedure-related deaths occurred. Useful life was achieved by 84% of all patients. CONCLUSION Antegrade drainage should be considered initially in patients who are likely to fail internal drainage (i.e., those with cervical cancer). The majority of these patients have a reasonably good quality of life, and intervention is most often warranted.
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Affiliation(s)
- M I Feng
- Department of Urology, Kaiser Foundation Hospital, Los Angeles, California 90027, USA
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PAUER WALTER, ECKERSTORFER GUDRUNM. USE OF SELF-EXPANDING PERMANENT ENDOLUMINAL STENTS FOR BENIGN URETERAL STRICTURES: MID-TERM RESULTS. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68549-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kulkarni RP, Bellamy EA. A new thermo-expandable shape-memory nickel-titanium alloy stent for the management of ureteric strictures. BJU Int 1999; 83:755-9. [PMID: 10368191 DOI: 10.1046/j.1464-410x.1999.00054.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the ease on insertion, patient tolerance, undesirable side-effects, degree of encrustation and duration of upper tract decompression with a new thermo-expandable shape memory alloy ureteric stent. PATIENTS AND METHODS From November 1996 to October 1998, 15 patients with ureteric strictures were treated with a new nickel-titanium shape-memory alloy stent, the Memokath 051 (Engineers & Doctors A/S, Hornbaek, Denmark). A total of 22 insertions were carried out. Ureteric obstruction was caused by recurrent colorectal carcinoma in four patients; two patients each with transitional cell carcinoma of the bladder, iatrogenic injury or ischaemia at the uretero-ileal anastomosis; and one patient each with metastatic lymph nodes from prostatic carcinoma, radiation-induced fibrosis, pelvi-ureteric junction obstruction, metastatic carcinoma of the vagina and extra-luminal endometriosis. The stent has a shaft diameter of 9 F and its proximal end expands to 17 F. The first three patients were treated with the original version, which expanded to 14 F. The unexpanded stent is inserted into the ureter after initial dilatation of the stricture to 12 F. The stent is expanded by injection with sterile water preheated to 50 degrees C. The procedures were carried out under a general anaesthetic and patients were allowed home the next day. The follow-up protocol included initial intravenous urography (IVU) at 6 weeks, with assessment of a mid-stream urine sample and renal function tests. These were repeated at 3-monthly intervals. Isotopic renography was performed when indicated. RESULTS The mean (range) follow-up was 10.6 (2-21) months; there was complete relief of upper tract obstruction in all patients. No stent-related symptoms, e.g. pain, sepsis, haematuria or frequency, were noted and no encrustation has occurred so far. The stent migrated in the first three patients with the original smaller diameter of stent but decompression of the upper tracts was maintained. None of the modified wider stents have migrated. The return of peristalsis in the proximal ureter was detected during IVU. There was no apparent endothelial growth through the stent material and no re-admissions for stent-related complications. CONCLUSION Early experience with this new stent is very encouraging. All patients have maintained satisfactory decompression of their upper tracts with no need for repeated hospitalization for stent changes. There have been no untoward side-effects so far. This stent appears to have a valuable place in the long-term management of ureteric strictures; it is probably most suited for malignant ureteric obstruction. It should be considered in the management of selected benign strictures that require long-term JJ stenting.
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Affiliation(s)
- R P Kulkarni
- Department of Urology, Ashford Hospital, Ashford, UK
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Pron G, Common A, Simons M, Ho CS. Interventional radiology and the use of metal stents in nonvascular clinical practice: a systematic overview. J Vasc Interv Radiol 1999; 10:613-28. [PMID: 10357489 DOI: 10.1016/s1051-0443(99)70092-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The intent of this systematic overview was to describe the clinical role of metal stents in nonvascular health care interventions and the level of evidence supporting their use. MATERIALS AND METHODS Structured searches of Medline were conducted and limited to original peer-reviewed articles published in English. RESULTS Clinical practice involving metal stents was reported in more than 109 clinical series involving 4,753 patients. Stents were placed mainly for palliation of malignant biliary, esophageal, and airway obstruction in patients who were untreatable or had surgically unresectable lesions. Assessment of these interventions has so far centered on safety and technical success. Efficacy, quality of life, and costing factors were not routinely reported. Randomized trial evidence was available but limited; six randomized trials involving metal stents have been reported. Three trials involved biliary malignant obstruction, and all three reported metal stent (132 patients) palliation to be superior to plastic stent palliation (136 patients) based on longer patency and lower reintervention costs. Safety and complication differences between stents, however, were inconsistent across trials. In three trials involving esophageal malignant obstruction, metal stent (82 patients) palliation was reported to be superior to plastic stent (41 patients), based on lower complication and reintervention rates, and superior to laser therapy (18 patients), based on better dysphagia relief. CONCLUSION Use of metal stents has been reported for obstructed ducts and passageways of most body systems. There is, however, limited controlled trial evidence confirming the advantages of their use over plastic stents or other forms of treatment.
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Affiliation(s)
- G Pron
- Department of Medical Imaging, University of Toronto, Ontario
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Lang EK, Irwin RJ, Lopez-Martinez RA, LaNasa J, Kasabian N, Watson RA. Placement of metallic stents in ureters obstructed by carcinoma of the cervix to maintain renal function in patients undergoing long-term chemotherapy. AJR Am J Roentgenol 1998; 171:1595-9. [PMID: 9843294 DOI: 10.2214/ajr.171.6.9843294] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Metallic stents, sometimes augmented by "J" endostents, were placed in ureters obstructed by advanced carcinoma of the cervix to improve or maintain renal function in these patients at a level necessary to pursue long-term chemotherapy and radiation therapy. SUBJECTS AND METHODS Seventeen ureters in 11 patients were treated with metallic stents, which were placed by an anterograde approach in 10 patients and by a retrograde approach in one. An anterograde ureteroneocystostomy was necessary in two of the 11 patients. J endostents were placed for I month in all patients. In 10 ureters, J endostents were reintroduced during follow-up 1-48 months later. RESULTS In 17 ureters, metallic stents were successfully placed; in the remaining three ureters, the procedures were aborted because of technical difficulties. The goal of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabilized at a range of 2.7-3.2 mg/dl in six more patients, permitting treatment with chemotherapy, radiation therapy, or both. Four of the 11 patients died within 4 months after treatment, and three more died within 2 years. At the time of death or last follow-up, seven metallic stents and eight combinations of metallic stents and J endostents were patent. Complications were minor. CONCLUSION Placement of metallic stents is recommended as an effective method to ensure patency and to facilitate cystoscopic replacement of J endostents in ureters compromised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy. Survival is governed by the effectiveness of chemotherapy and radiation therapy.
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Affiliation(s)
- E K Lang
- Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103-2714, USA
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A NEW SELF-EXPANDING LINED STENT-GRAFT IN THE DOG URETER: RADIOLOGICAL, GROSS, HISTOPATHOLOGICAL AND SCANNING ELECTRON MICROSCOPIC FINDINGS. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62436-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barbalias GA, Liatsikos EN, Karnabatidis D, Yarmenitis S, Siablis D. Ureteroileal anastomotic strictures: an innovative approach with metallic stents. J Urol 1998; 160:1270-3. [PMID: 9751333 DOI: 10.1016/s0022-5347(01)62513-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We report our experience with the use of self-expandable metallic stents to bypass anastomotic strictures after ureteroileal urinary diversion. MATERIALS AND METHODS We evaluated 3 men and 1 woman with invasive bladder carcinoma who underwent radical cystectomy and ileal conduit urinary diversion. Ureteroenteric anastomotic strictures developed after a mean of 16 months. Self-expandable metallic stents were successfully placed (bilaterally in 2) comprising 6 stented ureters that bypassed strictures. Mean patient age was 64 years and mean followup was 12 months. RESULTS No restenosis was observed in 3 patients during followup. The stricture recurred 1 month after stent placement in the remaining patient and additional intervention was necessary, consisting of placement of a totally coaxial overlapping metal stent. No sepsis or other complication was observed. One patient died of metastatic disease 12 months after stent placement. CONCLUSIONS We propose the use of metal stents as an adequate, safe and effective alternative treatment for anastomotic strictures after ureteroileal diversion.
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Affiliation(s)
- G A Barbalias
- Department of Urology, University of Patras, School of Medicine, Greece
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