Management of single double-J stent failure in malignant ureteral obstruction: tandem ureteral stenting with less frequent stent exchange

PURPOSE: To evaluate the safety and efficacy of the placement and exchange of tandem ureteral stents (TUS) under fluoroscopic guidance in the management of indwelling single double-J stent (DJS) failure in patients with malignant ureteral obstruction. We also aimed to investigate whether the generally accepted exchange period of DJSs could be extended using TUS. METHODS: This retrospective study involved 11 patients (10 female) with an age range of 27-64 years, median of 49 years, who underwent TUS (ipsilateral two 8F DJSs) placement due to indwelling single DJS failure occurring in less than 3 months. TUS exchanges were performed initially at 6-month intervals, and subsequent exchange intervals were extended to 9 and 12 months for seven patients. The interval from initial TUS placement to percutaneous nephrostomy, repeat exchange, or death was defined as the duration of stent patency. RESULTS: Indwelling single DJS failure occurred during a median follow-up of 45 days (range, 35-60 days) in 14 ureters of 11 patients. TUS were successfully placed and exchanged with a technical success rate of 100% without any early major complications. Thirty-nine procedures (11 placement and 28 exchange procedures) in 55 ureters were performed. The median duration of urinary patency was significantly higher with TUS [300 days (range, 60-440 days)] compared with single DJSs [45 days (range, 35-60 days)] (P < 0.001). CONCLUSION: The placement and exchange of TUS can be safely and effectively performed under fluoroscopic guidance. The need for frequent DJS exchange could be reduced with increased duration of stent patency using TUS.

Radiofrequency ablation of unresectable hepatic tumors.

PURPOSE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) in the treatment of primary and metastatic liver malignancies. MATERIALS AND METHODS: Twenty-nine consecutive patients who have primary (n=9) and metastatic (n=20) liver malignancies were treated with RFA. The total number of lesions were 62 at the initiation of treatment and 28 new lesions were diagnosed at the follow-up period. Totally, 84 lesions were ablated with RFA technique at 46 sessions. Primary tumors that gave rise to metastatic lesion were all colorectal cancer except one with gallbladder carcinoma. The greatest tumor diameter immediately before treatment was 0.8-5 cm with a mean of 2.5 cm. RESULTS: In the hepatocellular carcinoma (HCC) group, 1 patient was lost to follow-up, 5 deceased due to extensive disease, and 3 are still on the follow-up. In the metastatic liver disease group, 8 patients died due to progression of disease, 1 deceased due to stroke, and 3 were lost to follow-up. Nine patients with HCC had 14 nodules with a mean of 1.75 lesions/patient and 20 patients had 70 metastatic lesion with a mean of 3.1 lesions/patient. Residual viable neoplastic tissue was found at control computed tomography in 1 (1/14) lesion and recurrence occurred in 3 (3/14) lesions in HCC group. Recurrence occurred in 7 lesions (7/70) of 4 patients (4/20) in the metastatic liver disease group. Drainage requiring empyema took place in 1 patient and skin burn was observed in 2 as complications due to procedure. CONCLUSION: RFA of primary and metastatic liver malignancies is a safe and effective tool for local control of disease in unresectable hepatic malignancies.