Abstract
Self-expandable metal stents (7 mm in diameter) combined with coaxial double-j stents were placed in 10 ureters in ten patients with malignant ureteral obstruction. After 2 and 3 months, when the double-j stents were removed in seven patients, six patients developed hydronephrosis and one patient tolerated removal of the double-j stent and had no signs of urinary obstruction until she died in the fifth month. A double-j stent was inserted again in six patients who developed hydronephrosis. Endoscopy performed during insertion of the double-j stents showed urothelial hyperplasia and incrustations which reduced the lumen of the metal stent. Their double-j stents were exchanged with new ones every 3 months. In the last three patients, double-j stents were not removed, but exchanged with new ones every 3 months. Endoscopy performed regularly during the exchange of the double-j stents in the follow-up of nine patients showed that urothelial hyperplasia, although mild, persisted until the sixth month in three patients. We conclude that urothelial hyperplasia and incrustations limit the use of metal stents in malignant ureteral obstruction. Metal stents, however, when used together with the coaxially placed double-j stents, contributed to the achievement of internal urinary drainage in this study. Since a metal stent provides a buttress for the previously obstructed segment of the ureter, the lumen, although decreased by hyperplasia and incrustations, is held open, which allows an easy exchange of the double-j stent. Regarding the high cost of metal stent, use of it with a coaxial double-j stent should be spared for the malignant ureteral obstructions when a previously placed double-j stent alone fails to achieve efficient drainage.
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References
Stables DP (1982) Percutaneous nephrostomy: techniques, indications, and results. Urol Clin North Am 9: 15–29
Pfister RC, Newhouse JH (1979) Interventional percutaneous pyeloureteral techniques: II. Percutaneous nephrostomy and other procedures. Radiol Clin North Am 17: 351–363
Docimo SG, Dewolf WC (1989) High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions. J Urol 142: 277–279
Adam A, Chetty N, Roddie M, Yeung E, Benjamin IS (1991) Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR 156: 321–325
Rousseau H, Puel J, Joffre F et al. (1987) Self expanding endovascular prosthesis: an experimental study. Radiology 164: 709–714
Milroy EJG, Cooper JE, Wallsten H et al. (1988) A new treatment for urethral strictures. Lancet 1: 1424–1427
Machan L, Jager HL, Adam A, Gill K, Williams G, Allison DJ (1989) Benign prostatic hypertrophy: treatment with a metallic stent. AJR 153: 779–781
Pauer W, Lugmayr H (1992) Metallic Wallstents: a new therapy for extrinsic ureteral obstruction. J Urol 148: 281–284
Lugmayr H, Pauer W (1992) Self-expanding metal stents for palliative treatment of malignant ureteral obstruction. AJR 159: 1091–1094
Flueckiger F, Lammer J, Klein GE, Hausegger K, Lederer A, Szolar D, Tamussino K (1993) Malignant ureteral obstruction: preliminary results of treatment with metallic self-expandable stents. Radiology 186: 169–173
Van Sonnenberg E, DÁgustino HB, O'Laoide R, Donaldson J, Sanchez RB, Hoyt A, Pittman CC (1994) Malignant ureteral obstruction: treatment with metal stents — techniques, results, and observations with percutaneous intraluminal US. Radiology 191: 765–768
Saltzman B (1988) Ureteral stents: indications, variations, and complications. Urol Clin North Am 15(3): 481–491
Cussenot O, Bassi S, Desgrandchamps F, Bron J, Cortesse A, Teillac P, Le Duc A (1993) Outcomes of non-self-expandable metal prostheses in structured human ureter: suggestions for future developments. J Endourol 7(3): 205–209
Millward SF, Thijssen AM, Marriner JR, Moors DE, Mai KT (1991) Effect of a metallic balloon-expanded stent on normal rabbit ureter. JVIR 2: 557–559
Wright KC, Dobben RL, Magal C, Ogawa K, Wallace S, Gianturco C (1993) Occlusive effect of metallic stents on canine ureters. Cardiovasc Intervent Radiol 16: 230–234
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Correspondence to: S. Men
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Hekimo<glu, B., Men, S., Pinar, A. et al. Urothelial hyperplasia complicating use of metal stents in malignant ureteral obstruction. Eur. Radiol. 6, 675–681 (1996). https://doi.org/10.1007/BF00187672
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DOI: https://doi.org/10.1007/BF00187672