Alteplase Instillation for Upper Urinary Tract Clot Dissolution

Upper tract heparin instillation for maintenance of ureteral stent patency

PURPOSE

The study aimed to evaluate the efficacy of heparin packing after antegrade ureteral stent placement in the renal pelvis to protect against early dysfunction.

METHOD

From December 2019 to September 2021, 44 double J (DJ) stent placements were performed with heparin packing (heparin packing group). Between February 2008 and March 2014, 250 DJ stent placements without heparin packing were performed (control group). One-week patency and 3-month patency of the two groups were compared. The patency of the DJ stent according to the blood retention grade in the urinary system was also compared by subgroup analysis.

RESULT

The 1-week patency rate in the heparin packing group was significantly higher compared to the control group (88.6% and 65.2%, respectively, p = 0.002). There was no significant difference in the 3-month patency rate between the two groups (72.7% and 60.9%, respectively; p = 0.187). In the subgroup analysis, among the patients with high blood retention grades, the 1-week patency rates of the heparin packing group were significantly higher than that of the control group (100% and 60.9%, respectively; p < 0.001).

CONCLUSION

Heparin packing through the catheter after DJ stent installation aids in DJ stent patency.

Using alteplase nephrostomy tube installation for thrombolysis of ureter tract clot obstruction

In literature, few cases have been reported regarding the use of alteplase installation in a nephrostomy as anticoagulant treatment of blood clots in the upper urinary tract. Our case -report provides a unique case of alteplase installation in the nephrostomy tube for thrombolysis of a blood clot formation in the upper ureter. The blood clot formation emerged as acute obstruction following a planned endoscopic lithotripsy. A new protocol for alteplase installation for percutaneous nephrostomy is presented in this article.