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Antegrade stents are commonly used to relieve malignant and benign ureteric obstruction. However, follow up of these patients often involves several specialties and the potential for delayed management and forgotten stents. This observational study reviews indications and outcomes of antegrade stent procedures at one university hospital to provide prognostic and quality improvement data.
Patients and Methods
A retrospective analysis of 152 antegrade stent procedures in 142 patients over a 27-month period was performed. Cohorts were studied according to underlying pathology, referring specialty and intended duration of stent placement. Measured outcomes were time to stent removal or stent exchange, death, forgotten stents and complications.
The overall technical success rate of antegrade stent insertion was 98%. Follow-up data was available for 145 successful procedures in 138 patients. Malignancy (47%) and stone disease (35%) were the commonest indications. Overall, 43 patients (31%) died over a median follow up period of 2.2 years. 29 of 64 patients (45%) with malignancy died with stents in situ after a median interval of 3.5 months. Malignancy and unclear intended duration of stent placement were predictors of death with a stent in situ. Twelve patients (9%) had forgotten stents and a strong association with gynaecological malignancy was noted, which is felt to represent inadequate follow up of patients with non-urological pathology. Complications were reported in thirteen patients (9%), including ten cases of heavy stent encrustation and one malpositioned stent.
Prognostic factors should be considered in the management of patients stented for malignant obstruction, which is usually a marker of advanced disease. The hazards of inadequate follow up are highlighted, causing delays in stent removal and exchange, or the forgotten stent. Interventions are described to minimize these risks.
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2. Hausegger KA and Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 2006;16: 2016–30. 2006/03/18. DOI: 10.1007/s00330-005-0136-7.
3. Monga M, Klein E, Castañeda-Zúñiga WR, et al. The forgotten indwelling ureteral stent: a urological dilemma. J Urol 1995;153:1817–19.
4. Hsu L, Li H, Pucheril D, et al. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol 2016;5:172–81. DOI: 10.5527/wjn.v5.i2.172.
5. Kouba E, Wallen EM and Pruthi RS. Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 2008;180:444–50. 2008/06/14. DOI: 10.1016/j.juro.2008.04.008.
6. Cordeiro MD, Coelho RF, Chade DC, et al. A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients. BJU Int 2016;117:266–71. 2015/05/24. DOI: 10.1111/bju.12963.
7. Sohrab A, Aneesh S, Sureka SK, et al. Forgotten Reminders: an Experience with Managing 28 Forgotten double-J stents and management of related complications. Indian J Surg 2015;77:1165–71. 2015/01/24. DOI: 10.1007/s12262-015-1229-4.
8. Rao AR, Alleemudder A, Mukerji G, et al. Extra-anatomical complications of antegrade double-J insertion. Indian J Urol 2011;27:19–24. DOI: 10.4103/0970-1591.78408.