Abstract
Purpose
We assessed the feasibility of fluoroscopically guided transurethral replacement of ureteral stents as an alternative to cystoscopy.
Materials and methods
Over the last year, we replaced 27 double-J ureteral stents in 20 patients (10 men and 10 women; mean age 67.7 years, range 43–83); 15/20 patients had a native kidney, 3/20 had a transplanted kidney and 2/20 had a ureteroileal conduit. The procedures were performed in the angiography suite with the patient under sedation. All stents were grasped with a gooseneck snare under fluoroscopic control, and the distal end was withdrawn just outside the urethra; then a wire was advanced through the stent lumen and positioned in the renal pelvis. The stent was then removed and replaced with a new double-J stent.
Results
The procedures were successful in 26/27 cases. We observed 7 cases of mild haematuria that resolved spontaneously. During follow-up (1–16 months, mean 6.7), stent obstruction occurred in 4 cases, requiring an additional retrograde replacement.
Conclusions
Transurethral fluoroscopically guided retrograde replacement of dysfunctioning ureteral stents is an effective and safe alternative to cystoscopy.
Riassunto
Obiettivo
Valutare la fattibilità della sostituzione transuretrale con guida fluoroscopica degli stent ureterali, come alternativa alla cistoscopia.
Materiali e metodi
Nel corso dell’ultimo anno abbiamo sostituito 27 stent ureterali in 20 pazienti (10 maschi e 10 femmine; età media 67,7 anni, range 43–83); 15/20 in reni nativi; 3/20 in pazienti portatori di trapianto renale e 2/20 in pazienti con uretero-ileo-cutaneostomia. Le procedure sono state espletate in sala angiografica in sedazione. Tutti gli stent sono stati agganciati per via transuretrale utilizzando un catetere “gooseneck”; l’estremo distale dello stent è stato quindi retratto al di fuori del meato uretrale. Successivamente è stato introdotto un filo guida attraverso lo stent posizionandolo nella pelvi renale. Quindi lo stent è stato rimosso e sostituito con un nuovo stent 8F doppio J.
Risultati
La procedura è riuscita tecnicamente in 26/27 casi. Abbiamo osservato 7 casi di ematuria moderata, a risoluzione spontanea. Durante il follow-up (1–16 mesi, medio 6,7) abbiamo osservato 4 occlusioni di stent, sostituiti sempre per via retrograda con guida fluooscopica.
Conclusioni
La procedura è una sicura ed efficace alternativa alla cistoscopia per la sostituzione retrograda degli stent ureterali non funzionanti.
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Carrafiello, G., Laganà, D., Mangini, M. et al. Fluoroscopically guided retrograde replacement of ureteral stents. Radiol med 112, 821–825 (2007). https://doi.org/10.1007/s11547-007-0186-9
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DOI: https://doi.org/10.1007/s11547-007-0186-9