1
|
Yang W, Tang W, Zheng X, Zhang M, Lu X, Chen Z, Ji C, Guo H. Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures. BMC Urol 2023; 23:161. [PMID: 37828507 PMCID: PMC10571485 DOI: 10.1186/s12894-023-01333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures. METHODS Eleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position. RESULTS All the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3-27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year. CONCLUSION Robot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.
Collapse
Affiliation(s)
- Wenjin Yang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Weinan Tang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xi Zheng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Mengjie Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xinyi Lu
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Zeqing Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
| |
Collapse
|
2
|
Kim HJ, Yoon CJ, Lee S, Lee JH, Choi WS, Lee CH. Comparison between antegrade versus retrograde ureteral stent placement for malignant ureter obstruction. J Vasc Interv Radiol 2022; 33:1199-1206. [PMID: 35809804 DOI: 10.1016/j.jvir.2022.06.024] [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: 01/26/2022] [Revised: 05/27/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the technical success of antegrade (AUS) and retrograde ureteral stent placement (RUS) in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS. MATERIALS AND METHODS This study retrospectively included 61 AUS (44 patients) performed under fluoroscopic guidance and 76 RUS (55 patients) under cystoscopic guidance performed in patients with MUO from January 2019 to December 2020. Technical success rates of the two techniques were compared using an inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures. RESULTS Technical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4% [95% CI, 35.4%-63.1%]). Independent predictors for technical failure of the RUS procedure were age ≥ 65 years (OR 5.56, 95% CI 1.73-21.27), ureteral orifice invasion (OR 4.21, 95% CI 1.46-13.46) and extrinsic cancer (OR 15.58, 95% CI 2.92-111.81). CONCLUSIONS The technical success rate of AUS was higher than that of RUS in patients with MUO. RUS failure was associated with age ≥ 65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.
Collapse
Affiliation(s)
- Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Seungjae Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chong-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
3
|
Ordek E, Kolu M, Demir M, Kati B, Pelit ES, Yagmur I. Antegrade placement of JJ catheter in the treatment of malignant ureteral obstruction: Retrospective analysis of a single centre. Arch Ital Urol Androl 2022; 94:91-96. [PMID: 35352533 DOI: 10.4081/aiua.2022.1.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible. METHODS In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined. RESULTS In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes. CONCLUSIONS Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.
Collapse
Affiliation(s)
- Eser Ordek
- Kahta State Hospital, Urology Department, Adiyaman.
| | - Mehmet Kolu
- Harran University, Faculty of Medicine, Radiology Department, Sanliurfa.
| | - Mehmet Demir
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Bulent Kati
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Eyyup Sabri Pelit
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Ismail Yagmur
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| |
Collapse
|
4
|
Palm CA, Canvasser NE, Culp WTN. Stenting of Malignant Urinary Tract Obstructions in Humans and Companion Animals. Vet Sci 2021; 9:vetsci9010013. [PMID: 35051097 PMCID: PMC8780232 DOI: 10.3390/vetsci9010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022] Open
Abstract
Urine retention secondary to neoplastic obstructions of the upper and lower urinary tracts is a life-threatening condition in both humans and companion animals. Stents can be placed to temporarily or permanently open obstructed urinary tract lumens and are often able to be placed using minimally invasive techniques with guidance via ultrasonography or fluoroscopy. The literature for these techniques is vast for humans and growing for companion animals. The below review provides a discussion of the principles of stenting and types of ureteral and urethral stents, as well as the techniques for placing these stents in humans and companion animals.
Collapse
Affiliation(s)
- Carrie A. Palm
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Correspondence: (C.A.P.); (W.T.N.C.)
| | - Noah E. Canvasser
- Department of Urologic Surgery, University of California-Davis Medical Center, Sacramento, CA 95817, USA;
| | - Willian T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Correspondence: (C.A.P.); (W.T.N.C.)
| |
Collapse
|
5
|
Grubert RM, do Carmo CEF, Morais Neto RS, Tibana TK, Santos RFT, Marchiori E, Nunes TF. Antegrade double-J stenting as an alternative to the retrograde approach: experience of the first 150 cases at a single center in Brazil. Radiol Bras 2021; 54:353-359. [PMID: 34866694 PMCID: PMC8630954 DOI: 10.1590/0100-3984.2020.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To present our clinical experience with percutaneous antegrade ureteral
stenting. Materials and Methods This was a single-center retrospective study in which we reviewed the
electronic medical records of patients who underwent percutaneous
image-guided antegrade ureteral stenting between January 2016 and August
2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15
years (range, 30-94 years). Patients were divided into two main groups:
those with malignant neoplasms; and those with non-neoplastic disease.
Technical and clinical success of the procedure were defined, respectively,
as maintenance of the patency of the urinary tract, with a reduction in the
degree of hydronephrosis, and as a reduction in the level of nitrogenous
waste. Postprocedural complications were categorized as major or minor
according to the CIRSE classification. Results The study sample comprised 150 antegrade stenting procedures performed in 90
patients, most of whom had previously undergone retrograde stenting that was
unsuccessful. The stenting was bilateral in 60 patients and unilateral in
30. Technical success was achieved in 143 (95.3%) of the procedures, whereas
seven procedures (4.6%) were unsuccessful. Failed procedures were
characterized by inability to place a stent or migration of a stent after
its placement. Complications occurred in 12 (8.0%) of the procedures. Of
those 12 complications, two were classified as major (bleeding) and 10 were
classified as minor (lumbar pain or infection). The most common techniques
used were the over-the-wire technique and the modified technique (in 58.0%
and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy
tube was inserted. Conclusion Percutaneous antegrade ureteral stenting is a safe, effective method for the
management of ureteral injuries and obstructions, due to malignant or benign
causes, when the retrograde approach has failed.
Collapse
Affiliation(s)
- Renata Motta Grubert
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Carlos Egydio Ferri do Carmo
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Reinaldo Santos Morais Neto
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Rômulo Florêncio Tristão Santos
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| |
Collapse
|
6
|
Chen CS, Kim JW, Shin JH, Li HL, Lee HJ, Ibrahim A, Jang EB. Usefulness of a long sheath in ureteral catheterization after failure of antegrade ureteral stent placement using a short sheath. Acta Radiol 2021; 62:1674-1678. [PMID: 33115243 DOI: 10.1177/0284185120969952] [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: 11/16/2022]
Abstract
BACKGROUND When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. PURPOSE To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. MATERIAL AND METHODS Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. RESULTS The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher's exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. CONCLUSION Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.
Collapse
Affiliation(s)
- Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Hyung Jin Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh. Saudi Arabia
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Tlili G, Ammar H, Dziri S, Ben Ahmed K, Farhat W, Arem S, Acacha E, Gupta R, Rguez A, Jaidane M. Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study. Ann Med Surg (Lond) 2021; 69:102726. [PMID: 34466220 PMCID: PMC8382984 DOI: 10.1016/j.amsu.2021.102726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Ureteral double- J stent is usually inserted by retrograde approach to treating obstructed upper urinary tract. The antegrade approach, can be suitable alternative in certain situations without general or spinal anesthesia. The present study demonstrates the indications, success rate, and complications of this approach in treatmenting malignant obstructive uropathy. Methods Data of consecutive patients with malignant obstructive uropathy who underwent antegrade ureteral stenting in the Department of Interventional Radiology at Sahloul hospital from January 2013 to February 2020 was retrieved and retrospectively analyzed. Result A total of 188 attempts of antegrade ureteral stent insertion was performed during the study period (left side = 78, right side = 82, bilateral = 14). The mean age was 54 years (range: 9–91 years). The indication of the antegrade stenting was the failure of retrograde approach in 63 patients.The single-stage approach was performed 103 times. A percutaneous nephrostomy was placed for the average duration of 22.4 days (range: 2–60 days) for subsequent attempts. Only four patients required general anesthesia. Ureteral obstruction was caused by bladder cancer (n = 92), uterine cancer (n = 31), prostate cancer (n = 28), colorectal cancer (n = 15) and retroperitoneal tumor (n = 8). A protective nephrostomy was left in situ in 44 cases for 48 h. Clinical success was achieved in 96% of the cases. Two and three patients required hospitalization for perirenal abscess and hematuria, respectively. Conclusion This retrospective study shows that antegrade ureteral stent insertion has a high success rate with minimal complications. Trial registration ClinicalTrials.gov Identifier: NCT04649970. Registered december 2, 2020- Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT04649970; Ureters are easily affected by malignant conditions resulting in the interruption of urinary drainage. Double J (JJ) stents placement is the most common method for relieving urinary obstruction in such cases. The percutaneous antegrade ureteral stenting (PAUS) technique is a relatively newer technique for ureteral stenting. PAUS can be used as an alternative route for relieving ureteral obstruction due to malignancies.
Collapse
Affiliation(s)
- Ghassen Tlili
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sonia Dziri
- Department of Nephrology, Sahloul Hospital, Sousse, Tunisia
| | | | - Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sofiene Arem
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Emir Acacha
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Arib Rguez
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mehdi Jaidane
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| |
Collapse
|
8
|
Nas OF, Oztepe MF, Kandemirli SG, Bilgin C, Ozkaya G, Inecikli MF, Kaygısız O. Predictors of antegrade ureteral stenting failure: a single-center experience in patients with malignant and benign ureteral obstruction. Abdom Radiol (NY) 2021; 46:2188-2194. [PMID: 33226456 DOI: 10.1007/s00261-020-02858-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/09/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. METHOD We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. RESULTS Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). CONCLUSION This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.
Collapse
|
9
|
Chung HTJ, Bhagia G. Perinephric Hematoma Associated with Pyelonephritis Following Ureteral Stent Placement for Ureteral Obstruction Causing Hydronephrosis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931404. [PMID: 33905403 PMCID: PMC8088786 DOI: 10.12659/ajcr.931404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Perinephric hematomas are rare, especially following ureteral stent placement. Etiologies of perinephric hematomas include post-extracorporeal shockwave lithotripsy, Wunderlich syndrome, and renal cell carcinoma, none of which occurred in our patient, who underwent stent replacement. Subcapsular renal hematoma, rather than a perinephric hematoma, can occur following double-J ureteral stent placement. Also, renal parenchymal perforation leading to perinephric hematoma development are complications of double-J ureteral stent placement. Herein, we present a case of a perinephric hematoma following a double-J ureteral stent placement for a ureteral obstruction causing hydronephrosis. CASE REPORT A 43-year-old woman with type 2 diabetes mellitus, hypertension, systemic lupus erythematosus, and recurrent nephrolithiasis presented to our hospital with left flank pain of a 1-day duration. The patient was found to have an obstructive kidney stone causing hydronephrosis. She underwent stent placement and then developed a perinephric hematoma days later. Typically, hematomas are treated conservatively and have spontaneous resolution. The patient received 2 weeks of intravenous antibiotics and 2 more weeks of oral antibiotics, and failed conservative treatment. She re-presented to our hospital 3 days after discharge. Upon the second admission, a perinephric drain was placed. The patient was given another course of antibiotics and was discharged 18 days later. CONCLUSIONS A perinephric hematoma is a rare complication after ureteral stent placement. Perinephric hematoma development can be decreased by controlling blood pressure, treating preoperative urinary tract infections, and shortening operating time during ureteroscopy. It is important to reevaluate potential causes of continued abdominal pain with laboratory testing and repeat imaging.
Collapse
Affiliation(s)
| | - Geeta Bhagia
- Department of Internal Medicine, Benefis Health System, Great Falls, MT, USA
| |
Collapse
|