Emam A, Elmoazen M, Shabayek M, Zriek AM, Gad HH. Evaluation of Galdakao-modified Valdivia position in endoscopic management of malignant ureteric obstruction.
Int Urol Nephrol 2022;
54:463-468. [PMID:
35084651 PMCID:
PMC8831257 DOI:
10.1007/s11255-022-03109-4]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
Background
Malignant ureteric obstruction (MUO) due to pelvic malignancies is challenging for endourological management and carries high failure rates for retrograde cystoscopic ureteric stenting.
Methods
We adopted Galdakao-modified Valdivia (GMV) position in the management of MUO in an operating room equipped with a C-arm fluoroscopy unit and an ultrasound device. We prospectively studied the added value of this approach in 50 cases who failed retrograde ureteric stenting.
Results
Thirty-seven (74%) cases were done under a high level of spinal anesthesia. Mean operative time was 62 min. Antegrade ureteric stenting succeeded in 45/50 (90%) patients who failed retrograde ureteric stenting. GMV position facilitated simultaneous retrograde and antegrade management of MUO. Eight patients (16%) underwent auxiliary cystoscopic procedures to reduce the mass over the ureteric orifice (UO) guided by antegrade methylene blue or over a probing antegrade guidewire. Nephrostomy tube was inserted in the same setting in 16/50 (32%) cases. Antegrade flow of contrast to the bladder (P < 0.001) and ureteric kinks rather than tight stenosis or infiltration of UO (P = 0.014) were significantly associated with the success of antegrade ureteric stenting. No major complications were encountered.
Conclusion
GMV position is an ideal choice for management of MUO as it allows simultaneous access to the lower and the upper urinary systems to accomplish ureteric stenting either in a retrograde or an antegrade fashion as well as the ability to insert a nephrostomy tube in the same setting, thus shortening the inpatient care and this should be the standard of care in cases with MUO.
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