Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study

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 ;

Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?

“…The use of JJ for drainage of BOKs has many challenges, including higher invasiveness, need of anesthesia, liability of obstruction, and impossible placement due to complete obliteration of the ureteral lumen. These limitations are potentially present with antegrade and retrograde placement[ 72 , 73 ]. These challenges led to the development of the JJ characteristics, ranging from the new materials to the pressure-based capabilities.…”

Stenting of Malignant Urinary Tract Obstructions in Humans and Companion Animals

“…Ureteral stents often have a double-J or double-pigtail configuration and span the length of the ureter from the renal pelvis to the bladder [1][2][3]. These stents have historically consisted of a polymer tube with multiple fenestrations to allow drainage, but metallic ureteral stents have also been designed in numerous configurations.…”

“…When stenting malignant obstructions, the technical failure rate of retrograde stent placement is higher compared to stenting benign lesions [3]. In humans, if retrograde ureteral stenting is unsuccessful or the UVJ is not visible, either a percutaneous nephrostomy tube or a percutaneous nephroureteral stent (NUS) (ureteral stent with a contiguous percutaneous drain) is typically placed.…”

“…Complications of ureteral stenting may include ureteral or vascular injury, local tissue reaction to the stent with subsequent tissue overgrowth, vesicorenal reflux, stent encrustation, pyelonephritis, bladder irritation, migration, and compression resulting in reobstruction [1,3,21]. Technical success (often defined as placement of the stents using an interventional technique) is generally considered very high, with most percentages being >94% in humans [2,3]. Ureteral stents appear to be better tolerated in companion animals and rarely require exchange when placed for malignancy.…”

Alternative materials for antegrade implantation of a double-J catheter in a public health system

“…( 1 , 2 ) It is an alternative to nephrostomy, which can be performed simultaneously or afterwards, offering lower risks of infection, accidental loss of nephrostomy, and increased patient’s quality of life. ( 3 , 4 )…”