Assessment of Vesicoureteral Reflux in Patients With Self-Retaining Ureteral Stents: Implications for Upper Urinary Tract Instillation

Abstract

VUR is not a guaranteed consequence of Double-J stent placement. Therefore, when upper urinary tract instillation with the Double-J technique is considered, a cystogram should be performed first to confirm the occurrence of reflux, determine the intravesical volume required to induce reflux and ascertain that the pertinent section of the ureter or pelvicaliceal system from which the tumor was initially removed is opacified during study. An interval that remains to be defined should be allowed between stent insertion and VUR assessment.

Review of Topical Treatment of Upper Tract Urothelial Carcinoma

“…Yossepowitch et al used performed cystograms with an indwelling stent in place and reported that retrograde flow occurred in only 56% of patients. Additionally, the mean minimal intravesical volume to obtain reflux was 170 mL, which is higher than the typically instilled treatment volume [10]. …”

Efficacy of instillations with chemotherapy or immunotherapy following endoscopic resection for upper tract urothelial carcinoma

“…On the other hand, depending solely on passive retrograde flow through an indwelling stent might not be beneficial. Yossepowitch et al reported that only 56% of patients with an indwelling stent demonstrated passive reflux after intravesical instillation, at volumes almost fourtimes the normal treatment volumes used for intravesical therapy (mean: 170 ml) [24]. Thus, it is prudent not only to confirm reflux using contrast material, prior to initiation of therapy, but also to establish the volume needed by which reflux all the way up to the renal pelvis is noted.…”

Comparison of 3 Upper Tract Anticarcinogenic Agent Delivery Techniques in an Ex Vivo Porcine Model

“…13 Furthermore, immediate measurements of the minimal required volume were significantly higher than late measurements (255 mL and 146 mL respectively, P <.001). 27 Thus, patients who receive maintenance topical therapy might require confirmation of minimal volume for VUR with each instillation, making this approach a potentially unreliable method of upper tract delivery.…”