The Use of Internal Stents in Chronic Ureteral Obstruction

Fiuk, Julia; Bao, Yige; Calleary, J.; Schwartz, Bradley F.; Denstedt, John D.

doi:10.1016/j.juro.2014.10.123

Cited by 71 publications

(41 citation statements)

References 48 publications

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“…However, in some pathological cases, localised shrinkage of the cross-sectional area of the ureter can occur, impairing the physiological passage of urine. This can be due to a number of conditions, such as kidney stones lodging within the ureteral lumen, tumours compressing the ureteral wall, or inflammatory strictures ( Figure 1a) [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

et al. 2020

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Obstructions of the ureter lumen can originate from intrinsic or extrinsic factors, such as kidney stones, tumours, or strictures. These can affect the physiological flow of urine from the kidneys to the bladder, potentially causing infection, pain, and kidney failure. To overcome these complications, ureteral stents are often deployed clinically in order to temporarily re-establish urinary flow. Despite their clinical benefits, stents are prone to encrustation and biofilm formation that lead to reduced quality of life for patients; however, the mechanisms underlying the formation of crystalline biofilms in stents are not yet fully understood. In this study, we developed microfluidic-based devices replicating the urodynamic field within different configurations of an occluded and stented ureter. We employed computational fluid dynamic simulations to characterise the flow dynamic field within these models and investigated bacterial attachment (Pseudomonas fluorescens) by means of crystal violet staining and fluorescence microscopy. We identified the presence of hydrodynamic cavities in the vicinity of a ureteric occlusion, which were characterised by low levels of wall shear stress (WSS < 40 mPa), and observed that initiation of bacterial attachment occurred in these specific regions of the stented ureter. Notably, the bacterial coverage area was directly proportional to the number of cavities present in the model. Fluorescence microscopy confirmed that the number density of bacteria was greater within cavities (3 bacteria·mm−2) when compared to side-holes of the stent (1 bacterium·mm−2) or its luminal surface (0.12 bacteria·mm−2). These findings informed the design of a novel technological solution against bacterial attachment, which reduces the extent of cavity flow and increases wall shear stress over the stent’s surface.

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Section: Introductionmentioning

confidence: 99%

A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

et al. 2020

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“…Although ureteral stents may support ureteral healing and relieve ureteral obstruction, they cause significant morbidity, including pain, irritating voiding symptoms, hematuria and infection [4,5]. For these reasons, routine D/J after FURS stenting is controversial.…”

Section: Discussionmentioning

confidence: 99%

Böbrek taşlarına uygulanan fleksibl üreterorenoskopi sonrası stent yerleştirilmesi son takipte taşsızlık oranını arttırabilir: Retrospektif tek merkezli çalışma

Kaygısız

Ozmerdiven

Gunseren

et al. 2018

Archives of Clinical and Experimental Medicine

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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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The Use of Internal Stents in Chronic Ureteral Obstruction

Abstract: Stenting in chronic ureteral obstruction is a complex and challenging problem. Much work is being done in this area and many options are being explored.

Cited by 71 publications

References 48 publications

A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

Böbrek taşlarına uygulanan fleksibl üreterorenoskopi sonrası stent yerleştirilmesi son takipte taşsızlık oranını arttırabilir: Retrospektif tek merkezli çalışma

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

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