Endourologic Management of Malignant Ureteral Obstruction: Indications, Results, and Quality-of-Life Issues

Sountoulides, Petros; Pardalidis, N.; Sofikitis, N.

doi:10.1089/end.2009.0157

Cited by 31 publications

(41 citation statements)

References 114 publications

(211 reference statements)

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“…Stent failure was defined as any ureteral unit (UU) in which stent insertion failed or any UU that continued to cause symptoms for the patient after stent placement (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Stents were inserted by three experienced urological surgeons on an outpatient basis, using local anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…The advantages of this procedure are its simplicity and convenience, with no requirement for hospitalization, and a cheaper cost. However, cystoscopic ureteral stent insertion is a challenging procedure even for the most experienced urologists, with a mean failure rate of 15.0-27.5% (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…While the majority of previous studies have focused on the factors for stent functional failure in patients with MUO, such as baseline levels of serum creatinine (SCr), degree of hydronephrosis and being male in gender (4,5,8), studies on the predictive factors for the failure of retrograde ureteral stent placement under local anesthesia in outpatients have been rare (10).…”

Section: Introductionmentioning

confidence: 99%

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Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

et al. 2015

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Abstract. Malignant ureteral obstruction (MUO) is an unpropitious sign that is commonly observed in patients with advanced incurable cancer. The present study aimed to evaluate predictive factors for the failure of retrograde ureteral stent insertion in the management of MUO in outpatients. A total of 164 patients with MUO were retrospectively assessed in this study. Clinical factors, including age, gender, type of malignancy, level of obstruction, cause of obstruction, pre-operative creatinine level, degree of hydronephrosis, condition of the contralateral ureter, prior radiotherapy, Eastern Cooperative Oncology Group performance status (ECOG PS), bladder wall invasion and technical failure, were recorded for each case. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for predicting the failure of retrograde ureteral stent insertion. In total, 38 out of 164 patients experienced bilateral obstruction, therefore, a total of 202 ureteral units were available for data analysis. The rate of insertion failure in MUO was 34.65%. Multivariate analyses identified ECOG PS, degree of hydronephrosis and bladder wall invasion as independent predictors for insertion failure. Overall, the present study found that rate of retrograde ureteral stent insertion failure is high in outpatients with MUO, and that ECOG PS, degree of hydronephrosis and bladder invasion are potential independent predictors of insertion failure.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

et al. 2015

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“…1,2 Decreases in renal blood flow and glomerular filtration occur after obstruction. Increased hydrostatic pressure causes damage to the tubulointerstitial compartment of the kidney.…”

Section: Introductionmentioning

confidence: 99%

Alleviation of Kidney Damage Induced by Unilateral Ureter Obstruction in Rats byRhodiola rosea

Üyetürk

Terzi

Kemahlı

et al. 2013

Journal of Endourology

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Purpose: To evaluate the efficacy of Rhodiola rosea extract in terms of alleviating the renal damage induced by unilateral ureter obstruction (UUO) in rats. Material and Methods: Thirty Wistar albino male rats were divided into five groups: (I) Control, (II) UUO 7 days, (III) UUO 7 days + extract,(IV) UUO 14 days, and (V) UUO 14 days + extract. Seven or 14 days after the initiation of the experimental procedure, the left kidneys of rats in all five groups were removed for histological examination, and their blood was drawn for biochemical measurements. Result: Median malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were, respectively, 39.4 (5.04) nmol/mL and 25.8 (8.01) nmol/minute/mL in group I, 77.9 (12.38) nmol/mL and 5.8 (1.95) nmol/minute/mL in group II, 48.7 (12.1) nmol/mL and 9.1 (2.3) nmol/minute/mL in group III, 58.5 (23.83) nmol/mL and 8.4 (2.1) nmol/minute/mL in group IV, and 44.8 (4.97) nmol/mL and 13.8 (3.73) nmol/minute/mL in group V. There was a statistically significant difference among the groups in terms of MDA and GPx levels ( p < 0.05 for both). The median numbers of apoptotic cells were 1 (1), 8 (2.25), 3 (1.25), 23.5 (9), and 7 (I) in groups I, II, III, IV, and V, respectively. There was a statistically siginificant difference among the groups in terms of apoptotic cell number ( p < 0.05). Conclusion: R. rosea extract was shown to alleviate the renal damage induced by UUO through its antioxidant effects. The mechanism by which R. rosea extract causes these effects merits further investigation.

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“…2,3 The procedure is frequently performed via flexible cystoscope in cysto-suite as an outpatient procedure. 4 In most cases, the procedure is straightforward; however, occasionally the guide wire loops in the bladder (Fig.1) preventing J stent insertion.…”

Section: Methodsmentioning

confidence: 99%

A new technique to prevent curling of guide wire in urinary bladder during J stent insertion with flexible cystoscope

Mahmood¹,

Pasha²

2016

CUAJ

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Insertion of J stent is a very common procedure performed by urologists. This procedure is often performed to relieve ureteral obstruction due to stones, tumours, ureteral kink, or stricture on urgent basis. An increasing number of urologists are using a flexible cystoscope and local anaesthetic for J stent insertion. Occasionally, the guide wire curls in the bladder, making it impossible to insert the J stent. Here, we describe a simple method to overcome this problem using modified ureteral dilator, which is usually available in the cystoscopy suite. MethodInsertion of J stent was first described to the urological society in 1978 by Finney et al.1 Indications for ureteral stent placement include ureteric obstruction due to benign or malignant conditions. 2,3 The procedure is frequently performed via flexible cystoscope in cysto-suite as an outpatient procedure. 4 In most cases, the procedure is straightforward; however, occasionally the guide wire loops in the bladder ( Fig.1) preventing J stent insertion. There are various ways to overcome this problem, including removing the guide wire and trying again, getting rid of the loop by holding the wire with forceps at the vesicoureteric junction, and straightening the loop or try different types of guide wires. Sometimes none of these methods work, resulting in prolonged operative time or abandoning the procedure.The next step is to resort to rigid cystoscope. The rigid cystoscope stabilizes the guide wire up to the ureteric orifice, preventing it from curling in the bladder. The use of rigid cystoscope requires changing the patient's position to lithotomy, redraping, asking for rigid scope setup, and may also require sedation or general anesthesia. The rigid cystoscope is less desirable under local anesthesia than flexible cystoscopy, as it is more painful. 5We came up with a new idea and used a 16 F ureteral dilator out of the ureteral dilator set made by Cook (AQ 076000).This is cut at the tip to allow the passage of 5 French J stent and also shortened to a length of 20 cm from its original length of 60 cm (Fig. 2). First, the guide wire is inserted via flexible cystoscope up to the ureteric obstruction or kink. This is followed by removal of flexible cystoscopy, leaving the guide wire in place. The modified ureteral dilator is then threaded over the guide wire under fluoroscopy control, with the tip of the dilator positioned at the upper end of the symphysis pubis. The J stent, followed by the pusher, is loaded over the wire. Progress of the bladder end of J stent is monitored by the metallic tip of the pusher, which is visible through the ureteral dilator with fluoroscopy.As the radio-opaque metallic tip is seen emerging from the ureteric dilator, the guide wire is removed, leaving the J stent in optimal position. Just like a rigid scope, the modified ureteral dilator stabilizes the guide wire close to the ureteric orifice under fluoroscopy to prevent the looping of wire in the bladder (Fig. 3). To our knowledge this technique has not been published b...

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Endourologic Management of Malignant Ureteral Obstruction: Indications, Results, and Quality-of-Life Issues

Cited by 31 publications

References 114 publications

Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

Alleviation of Kidney Damage Induced by Unilateral Ureter Obstruction in Rats byRhodiola rosea

A new technique to prevent curling of guide wire in urinary bladder during J stent insertion with flexible cystoscope

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