Antegrade Ureteral Stenting in Ureteral Obstruction / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Antegrade ureteral stenting was attempted in cases where cystoscopic retrograde ureteral stenting had been unsuccessful in the alleviation of a ureteral rupture, stricture or obstruction. Attempts were made to evaluate the clinical outcomes and technical issues of antegrade ureteral stenting in ureteral obstruction. MATERIALS AND METHODS: Between 1998 and 2003, antegrade ureteral stenting was attempted in 15 patients. Here, the results were retrospectively analyzed. Of the 15 patients, the retrograde ureteral stenting failed in 13. The causes of the ureteral obstructions were urological and nonurological malignancies in 12 patients, genitourinary tuberculosis in 2 and endoscopic ureteral trauma in 1. RESULTS: Thirteen of the 15 patients were successfully stented using the antegrade methods. One cervical cancer patient was stented using a pull-through technique. Four out of 6 patients with radiologically completely obstructed ureters were stented successfully. The ureteral stents were removed in two patients where the causes of the ureteral obstructions were relieved. Seven patients were successfully stented for the relief of obstructive renal failure, and all showed rapid decreases in their serum creatinine level and/or improvements on imaging studies. Five patients were successfully stented for the relief a ureteral obstruction, and all showed improvements on imaging studies. Changes of the ureteral stents were performed by cystoscopy in four patients. CONCLUSIONS: Antegrade ureteral stenting is an alternative technique for the alleviation of a ureteral obstruction should retrograde ureteral stenting not be possible. An antegrade ureteral stenting trail is recommended, even in the case of a radiologically complete obstruction on an antegrade ureterogram. Antegrade ureteral stenting is one of the choices for the alleviation of a ureteral obstruction unless the patient has an intravesical obstruction and the inability to move.