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Retrograde ureteric stent exchange in the female oncology patient by interventional radiology: the experience of a single tertiary referral centre

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Double-J stents are used to treat ureteric outflow obstruction. Deployed in antegrade or retrograde fashion, they relieve ureteric obstruction in several conditions including ureteric calculi, strictures and malignancy. Traditionally exchanged in an operating theatre (OT) under general anaesthetic (GA), more recently described is the technique of using fluoroscopic guidance under sedation.

Aims

To assess the efficacy and safety of retrograde double-J stent exchange in an interventional radiology (IR) setting in a tertiary oncology referral centre over a 7-year period.

Methods

Clinical data on 460 double-J stent exchanges in 126 female patients was acquired from the hospital electronic patient record. Four fellowship-trained interventional radiologists performed the procedures. A standard approach was used in conjunction with conscious sedation using midazolam and fentanyl. Use of the technique with certain anatomical variations is also described.

Results

Technical success rate was 96%. The main reasons for failure included failure to snare the stent (1.8%) and patient discomfort (1.1%). The overall complication rate was 5%: 5 category 1 (minor) and 18 category 3 outcomes, with the latter group requiring further intervention. Average screening time was 9.65 min and the average radiation dose was 2018.24 mGy/m2. We also demonstrate the successful use of this method in patients with unusual anatomy and ileal conduits.

Conclusion

Fluoroscopic-guided retrograde double-J stent exchange is a safe and effective procedure that can be performed with a high degree of success using equipment and techniques used in daily IR practice. This approach precludes the need for GA, reduces OT utilisation and is well tolerated in a patient group for whom this procedure is typically palliative.

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Abbreviations

EPR:

Electronic patient record

GA:

General anaesthetic

IR:

Interventional radiology

PUJ:

Pelvi-ureteric junction

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Authors and Affiliations

  1. Department of Radiology, St James’s Hospital, St James’s Street, Dublin 8, Ireland

    Roger Smyth, Douglas Mulholland, Michael Courtney, Ian Brennan, Niall McEniff, Michael Guiney & J. Mark Ryan

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  1. Roger Smyth
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  2. Douglas Mulholland
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  3. Michael Courtney
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  4. Ian Brennan
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  5. Niall McEniff
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  6. Michael Guiney
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  7. J. Mark Ryan
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Correspondence to Roger Smyth.

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The authors declare that they have no conflict of interest.

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Ethical approval was granted by the institution’s Research and Innovation Office (Ref no.: 5257).

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Key points

• We describe a method for retrograde fluoroscopic exchange of ureteric double-J stents in female patients.

• We also demonstrate the flexibility and adaptability of this technique to unusual anatomy as detailed by several challenging cases.

• Retrograde ureteric stent exchange is a safe alternative to rigid cystoscopic exchange which avoids a general anaesthetic and theatre time without compromising effectiveness.

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Smyth, R., Mulholland, D., Courtney, M. et al. Retrograde ureteric stent exchange in the female oncology patient by interventional radiology: the experience of a single tertiary referral centre. Ir J Med Sci 189, 1097–1104 (2020). https://doi.org/10.1007/s11845-020-02170-1

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  • DOI: https://doi.org/10.1007/s11845-020-02170-1

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