Purpose
The purpose of this study was to assess the routinely feasibility of transurethral retrieval and replacement ofdouble-J stents and to affirm the interventional radiology technique as an alternative to cystoscopic replacement.
Methods and materials
From January 2005 to December 2015 6167 DJ stents were replaced in 1168 Patients in 3221 procedures.
Male: 35,5%
Age (Average; range): 67.15; 27.5–89.8
Bilateral procedure: 75,7%
Repeted procedure: 87,3 % (Average; range: 4; 2-14).
Months from previous replacement (Average; range): 6.3; 1.3–14.2
Causes and Indications
Neoplasia: 83,8% (Urologic: 47,7% - gynaecological 24,7% - others: 27,6%)
Fibrotic obstructions: 16,2% (Ureteroileal anastomosis: 76,7% - kidney graft: 16,9% - others: 6%)
Technique:
- Disinfection and bladder catheterization with vascular introducer
7F 15 cm ♀; 23 cm ♂;...
Results
Technical success was achieved in 97.5% procedures. In eighty procedures, 111 stents (49 bilateral and 31 unilateral) presented encrusted lumen; replacement with this technique was not allowed; cystoscopic approach was
necessary.
Clinical success was reached in 3069 procedures (95.3%). During the follow-up period (9–73 months, mean44.2), there were 140 premature stent obstructions in 128 patients that were treated with further retrograde replacement under fluoroscopic guidance: 28 of them presented urinary infections associated with obstruction; moreover,during the follow-up, twelve patients presented pyonephrosis due to an occluded...
Conclusion
On the basis of technical and clinical successes reported (97.5 and 95.7%, respectively) and of the safety of the procedure, transurethral fluoroscopically guided replacement should be considered the first choice in most patients, in particular in patients who underwent routinely replacement, and only in few cases of technical failure, cystoscopy may be considered.
Personal information and conflict of interest
M. Curti; Varese, ITALY/IT - nothing to disclose A. Coppola; Varese/IT - nothing to disclose G. Vinacci; Varese/IT - nothing to disclose F. Piacentino; Varese/IT - nothing to disclose F. Fontana; Varese/IT - nothing to disclose A. Beneventi; Varese/IT - nothing to disclose C. Tagliaferri; Varese/IT - nothing to disclose E. Genovese; Varese/IT - nothing to disclose M. Calvi; Varese/IT - nothing to disclose
References
Trans-Urethral Ureteral Stent Replacement Technique (TRUST): 10-Year Experience in 1168 Patients.Gianpaolo Carrafiello, Andrea Coppola, Giuseppe De Marchi, Federico Fontana, Filippo Piacentino, Mario Petrillo, Alessandro Taborelli, Salvatore Alessio Angileri, Genti Xhepa, Nicola Macchione,et al.Cardiovasc Intervent Radiol.2017 Dec 12Published online 2017 Dec 12.doi:10.1007/s00270-017-1854-3
