Complications After Polymeric and Metallic Ureteral Stent Placements Including Three Types of Fistula

Song, Geehyun; Lim, Bumjin; Han, Kyungsik; Song, Sang Hoon; Park, Hyung Keun; Hong, Bumsik

doi:10.1089/end.2014.0394

Cited by 5 publications

(3 citation statements)

References 19 publications

(16 reference statements)

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“…In this case, CT findings revealed a pseudoaneurysm along the left distal ureter to the proximal sigmoid colon; the patient underwent immediate open nephrectomy, stent was removed and colon was repaired. Song et al [20] reported three types of fistula after metal stent placements, including ureteroarterial fistula, ureteroenteral fistula, and ureterovaginal fistula. When a patient with a metal stent visits the emergency room with a gross hematuria, fistula should be highly suspected.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of two types of metal stent for chronic benign ureteral strictures

et al. 2019

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Background We aimed to compare the results of long-term use of two types of metal stent for chronic benign ureteral strictures. Methods Our study included 46 ureter units (UUs) that underwent metal stent placement from 2010 to 2017. We included benign ureteral strictures causes by variety reasons that could not be solved by other treatment and malignant obstructions were excluded. Covered mesh stent (Uventa™) and a thermo-expandable stent (Memokath 051™) were used. Primary success was defined as maintaining patency without procedures and overall success was defined as maintaining patency with additional procedures. Results We placed covered mesh stents in 25 UUs and thermo-expandable stents in 21 UUs. The mean follow-up duration of each stent was 41.4 ± 23.1 and 34.4 ± 16.5 months ( p = 0.250). In the first year of stent insertion, primary success was achieved in 54.9 and 70.4% ( p = 0.204). Overall success was achieved in 78.7 and 75.4% in same duration, respectively ( p = 0.586). Longer stent placement had positive predictive value on both success rates (HR = 0.185, p = 0.047 and HR = 0.111, p = 0.018). Prior radiation therapy and non-pelvic ureter stricture both adversely affected the overall success rate (HR = 5.412, p = 0.048 and HR = 4.203, p = 0.030). Previous PCN status had negative predictive value for both success rates (HR = 4.014, p = 0.003 and HR = 3.064, p = 0.035). Conclusions The treatment outcomes of two types of metal stent were comparable, especially in the first year of stent insertion. Electronic supplementary material The online version of this article (10.1186/s12894-019-0465-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of two types of metal stent for chronic benign ureteral strictures

et al. 2019

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“…A recent comparative study, including polymeric and metallic stents, mentioned occurrence of ureteroiliac artery, ureteroenteral, and ureterovaginal fistulas after insertion of polymeric stents and self-expandable metallic stents, but not with Memokath stents. 3 UEAF is very rare and generally iatrogenic, occurring in patients with previous radiation therapy, pelvic surgery, or chronic indwelling stents and is more likely in the presence of vascular disease. 4 The common iliac artery at the level of the ureter is the most common site, followed by the external iliac and internal iliac arteries.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Ureteroiliac Artery Fistula Caused by a Metallic Memokath Ureteral Stent in a Radiation-Induced Ureteral Stricture

Das

Ordones

Welikumbura

et al. 2016

Journal of Endourology Case Reports

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Background: Memokath 051™ stents are increasingly used for management of benign and malignant ureteral strictures refractory to management with single or tandem polymeric Double-J ureteral stents. Migration, encrustation, and difficulty in extraction during stent exchange are the chief problems reported so far with these thermoexpandable metallic stents. We report an unusual complication of ureteroexternal iliac artery fistula (UEAF) caused by Memokath stent inserted for radiation-induced ureteral stricture.Case Presentation: A 71-year-old male with history of colorectal cancer (underwent extirpative surgery + chemoradiotherapy) and subsequently radiation-induced ureteral stricture had bilateral Memokath ureteral stents inserted. Three months later, he presented with sepsis and hemodynamic instability secondary to UEAF, confirmed on angiography. A covered vascular stent was inserted as an immediate management.Conclusion: Memokath stent insertion in radiation-induced ureteral strictures may be associated with an increased risk of erosion and the rare potential complication of UEAF. This potential risk needs to be considered in the overall setting of such strictures and the difficulty in treating them. Prompt imaging (angiography) and placement of an endovascular stent are the ideal immediate options in such cases.

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“…Uretero-arterial fistula (UAF) is a rare but potentially life-threatening complication that should be considered in patients presenting with intermittent gross hematuria and a history of pelvic surgery/radiation, ureteral manipulation and chronic cannulation [1,2]. UAF arises where the cannulated ureter and the common or external iliac artery overlap.…”

Section: Introductionmentioning

confidence: 99%

Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication

Perrenoud

Heiberger

Shriver

et al. 2020

Cureus

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The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed an uretero-arterial fistula after prolong ureteral stenting and exchanges following ileal conduit obstruction. Initial treatment with left common iliac stenting controlled the hematuria, but only temporarily. Repeat angiography revealed a type 1b endoleak requiring stent extension. Unfortunately, persistent hematuria necessitating further angiography showed the development of a saccular pseudoaneurysm around the stent graft requiring proximal stent extension. A nuclear medicine indium 111-tagged white blood cell scan with single-photon emission CT (SPECT)/CT confirmed stent graft infection. Conservative therapy with antibiotics failed, causing graft failure that ultimately required bypass surgery.

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Complications After Polymeric and Metallic Ureteral Stent Placements Including Three Types of Fistula

Abstract: UAF should be highly suspected in patients with long-term ureteral stents, especially if gross hematuria develops. The placement of a metallic ureteral stent using a high-pressure balloon should be performed cautiously, especially in patients with a history of pelvic surgery or radiation.

Cited by 5 publications

References 19 publications

Long-term outcomes of two types of metal stent for chronic benign ureteral strictures

Long-term outcomes of two types of metal stent for chronic benign ureteral strictures

Ureteroiliac Artery Fistula Caused by a Metallic Memokath Ureteral Stent in a Radiation-Induced Ureteral Stricture

Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication

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