PRIMARY AND SECONDARY URETERIC STENTING IN URETERIC OBSTRUCTION: AN OBSERVATIONAL STUDY

Abstract

Background: Patients with benign/malignant ureteric strictures are often treated with ureteric stenting. Most patients who undergo antegrade ureteric stenting are sent to interventional radiology when retrograde stenting is not possible. The insertion of a ureteric stent renders the patient tubeless and avoids nephrostomy tube associated problems. Antegrade stenting is conventionally performed as a two-stage procedure for various reasons, but, more recently, a one-stage approach has been adopted.

OBJECTIVE: The aim of this study was to evaluate the procedural success, complications, and procedural cost of antegrade ureteric stenting.

STUDY DESIGN: an observational study

PARTICIPANTS: A total of 21 patients (12 males, 9 females, mean age 48 years) with obstructive hydronephrosis of benign or malignant origin were enrolled in our study.

METHODS: Antegrade ureteric stenting was attempted in a total of 21 patients.10 (48%) patients were subjected to primary stenting, and the rest of the patients were subjected to the conventional two-stage procedure. Endpoint assessments were technical and clinical success rates, procedural complications, and procedure-related costs. Failure was defined as the persistence of high levels of serum creatinine or inability to place stents percutaneously.

RESULTS: A total of 26 procedures in 21 patients were done in the study: 16 procedures in 11 patients were in the secondary group, and 10 procedures in 10 patients were in the primary group. Our technical success rates were 87% and 80% in secondary and primary groups, respectively. The overall technical and clinical success rate in our study was 84.6% and 85%, respectively. Five out of 21 patients developed (23.8%) minor complications; however, there were no major complications in our study. The average cost of primary stenting was significantly lower than the secondary stenting in our study.

CONCLUSION: Percutaneous antegrade ureteral stent placement is a safe and effective method for manage­ment of ureteric obstructions due to both malignant and benign causes when the retrograde approach has failed and when the retrograde approach is difficult. In carefully selected patients, primary antegrade ureteric stenting is a technique with a high success rate at lower costs.

IMPLICATIONS: we recommend antegrade ureteric stenting as a salvage procedure in relieving ureteric obstruction in patients where retrograde stenting is impossible or difficult.