Antegrade placement of JJ catheter in the treatment of malignant ureteral obstruction: Retrospective analysis of a single centre
https://doi.org/10.4081/aiua.2022.1.91
Accepted: March 14, 2022
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Objective: The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible.
Methods: In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined.
Results: In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes.
Conclusions: Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.
Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967; 97:840-4. DOI: https://doi.org/10.1016/S0022-5347(17)63130-6
Seymour H, Patel U. Ureteric stenting: Current status. Semin Intervent Radiol. 2000; 17:351-65. DOI: https://doi.org/10.1055/s-2000-13148
Nunes TF, Tibana TK, Santos RFT, et al. Percutaneous insertion of bilateral double J stent. Radiol Bras. 2019; 52:104-105. DOI: https://doi.org/10.1590/0100-3984.2017.0230
Fletcher HM, Wharfe G, Williams NP, et al. Renal impairment as a complication of uterine fibroids: a retrospective hospital-based study. J Obstet Gynaecol. 2013; 33:394-8. DOI: https://doi.org/10.3109/01443615.2012.753421
Meira MS, Barbosa PNV, Bitencourt AGV, et al. Análise retrospectiva das nefrostomias percutâneas guiadas por tomografia computadorizada em pacientes oncológicos. Radiol Bras. 2019; 52:148-54. DOI: https://doi.org/10.1590/0100-3984.2018.0023
Hsu L, Li H, Pucheril D, et al. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol. 2016; 5:172-81. DOI: https://doi.org/10.5527/wjn.v5.i2.172
Chitale SV, Scott-Barrett S, Ho ET, Burgess NA. The management of ureteric obstruction secondary to malignant pelvic disease. Clin Radiol. 2002; 57:1118-21. DOI: https://doi.org/10.1053/crad.2002.1114
Venyo AKG, Hanley T, Barrett M, et al. Ante-grade ureteric stenting, retrospective experience in managing 89 patients: indications, complications and outcome. Journal of Biomedical Graphics and Computing. 2014; 4:47-56. DOI: https://doi.org/10.5430/jbgc.v4n3p47
Bahu R, Chaftari AM, Hachem RY, et al. Nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors. J Urol. 2013; 189:130-5. DOI: https://doi.org/10.1016/j.juro.2012.08.094
Dyer RB, Regan JD, Kavanagh PV, et al. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002; 22:503-25. DOI: https://doi.org/10.1148/radiographics.22.3.g02ma19503
van der Meer RW, Weltings S, van Erkel AR, et al. Antegrade ureteral stenting is a good alternative for the retrograde approach. Curr Urol. 2016; 10:87-91. DOI: https://doi.org/10.1159/000447157
Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure. Int J Clin Oncol. 2019; 24:306-312. DOI: https://doi.org/10.1007/s10147-018-1348-6
Kamiyama Y, Matsuura S, Kato M, et al. Stent failure in the management of malignant extrinsic ureteral obstruction: risk factors. Int J Urol. 2011; 18:379-82. DOI: https://doi.org/10.1111/j.1442-2042.2011.02731.x
Yu SH, Ryu JG, Jeong SH, et al. Predicting factors for stent failure-free survival in patients with a malignant ureteral obstruction managed with ureteral stents. Korean J Urol. 2013; 54:316-21. DOI: https://doi.org/10.4111/kju.2013.54.5.316
Turgut B, Bayraktar AM, Bakdık S, et al. Placement of double-J stent in patients with malignant ureteral obstruction: antegrade or retrograde approach? Clin Radiol. 2019; 74:976.e11-976.e17. DOI: https://doi.org/10.1016/j.crad.2019.08.006
Kahriman G, Özcan N, Dogan A, et al. Percutaneous antegrade ureteral stent placement: single center experience. Diagn Interv Radiol. 2019; 25:127-133. DOI: https://doi.org/10.5152/dir.2019.18252
Uthappa MC, Cowan NC. Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction? Clin Radiol. 2005; 60:608-12. DOI: https://doi.org/10.1016/j.crad.2004.11.014
Adamo R, Saad WE, Brown DB. Management of nephrostomy drains and ureteral stents. Tech Vasc Interv Radiol. 2009; 12:193-204. DOI: https://doi.org/10.1053/j.tvir.2009.09.003
Pabon-Ramos WM, Dariushnia SR, Walker TG, et al. Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol. 2016; 27:410-4. DOI: https://doi.org/10.1016/j.jvir.2015.11.045
Ganatra AM, Loughlin KR. The management of malignant ureteral obstruction treated with ureteral stents. J Urol. 2005; 174:2125-8. DOI: https://doi.org/10.1097/01.ju.0000181807.56114.b7
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