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• W2023504021 abstract "No AccessJournal of UrologyClinical Urology: Urologists At Work1 Jan 1998THE USE OF 2 IPSILATERAL URETERAL STENTS FOR RELIEF OF URETERAL OBSTRUCTION FROM EXTRINSIC COMPRESSION John S. Liu and Ronald L. Hrebinko John S. LiuJohn S. Liu More articles by this author and Ronald L. HrebinkoRonald L. Hrebinko More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64050-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present our early experience with the novel approach of placing 2 parallel stents simultaneously in extrinsically obstructed ureters in which single stents had failed. The increased stiffness of 2 stents reduces kinking and luminal compression, and the potential space between the stents likely preserves flow around as well as through them. Materials and Methods: Four patients recently presented with ureteral obstruction secondary to nonurinary tract malignancies. Previous stenting with a single 6F Double-J* Medical Engineering Corp., New York, New York. stent had failed in all cases. Three patients experienced flank pain and 1 had persistent azotemia within 3 days of initial stent placement. All patients had significant residual sonographic hydronephrosis despite good stent position. In all cases cystoscopy/stent exchange was performed under local anesthesia with intravenous sedation. Parallel 4.7F Double-J stents were placed simultaneously over 2, 0.035 hydrophilic coated glide wires under fluoroscopic guidance after removal of the malfunctioning 6F stent. Results: Stent placement was uneventful in all 4 patients with prompt drainage of contrast material seen after parallel ipsilateral stent placement. Patients tolerated the double 4.7F parallel stents with no discernible difference in irritative symptoms compared to single 6F stents. Flank pain and azotemia resolved in 3 patients, and hydronephrosis improved in all 4 after placement of parallel Double-J stents. All patients remain alive with a mean followup of 5.8 months (range 4 to 8). Except for 1 patient who later underwent ureterolysis, each had subsequently had the stent changed every 3 months. No patient has required proximal urinary diversion (that is percutaneous nephrostomy tube). Conclusions: Placement of 2 ipsilateral parallel ureteral stents simultaneously is an easy technique. It may obviate percutaneous nephrostomy tube placement in patients in whom drainage with a single stent failed, especially in cases of extrinsic ureteral compression. References 1 : High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions.. J. Urol.1989; 142: 277. Abstract, Google Scholar 2 : The effects of double J stenting on unobstructed ureters. An experimental and clinical study.. Brit. J. Urol.1985; 57: 630. Google Scholar 3 : The Double-J ureteral stent: in vivo flow studies.. J. Urol.1992; 148: 278. Abstract, Google Scholar 4 : The mechanisms of urine transport in the upper urinary tract: 1. The dynamics of the isolated bolus.. Neurourol. Urodynam.1983; 2: 155. Google Scholar 5 : The mechanics of urine transport in the upper urinary tract: 2. The discharge of the bolus into the bladder and dynamics at high rates of flow.. Neurourol. Urodynam.1983; 2: 167. Google Scholar 6 : Double-J and diversion stents.. Urol. Clin. N. Amer.1982; 9: 89. Google Scholar 7 : Biocompatibility of various indwelling Double-J stents.. J. Urol.1995; 153: 494. Abstract, Google Scholar 8 : Uretero-renal reflex facilitating renal vasoconstrictor responses to emotional stress.. Amer. J. Physiol.1958; 192: 191. Google Scholar 9 : Metallic Wallstents: a new therapy for extrinsic ureteral obstruction.. J. Urol.1992; 148: 281. Abstract, Google Scholar 10 : Wallstents for the treatment of extrinsic malignant ureteral obstruction: midterm results.. Radiology1996; 198: 105. Google Scholar 11 : The pigtail ureteral stent in the cancer patient.. J. Urol.1979; 121: 17. Abstract, Google Scholar From the Division of Urologic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaAccepted for publication June 27, 1997© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byChristman M, Kasturi S, Lambert S, Kovell R and Casale P (2018) Endoscopic Management and the Role of Double Stenting for Primary Obstructive MegauretersJournal of Urology, VOL. 187, NO. 3, (1018-1023), Online publication date: 1-Mar-2012.Christman M, L'Esperance J, Choe C, Stroup S and Auge B (2018) Analysis of Ureteral Stent Compression Force and its Role in Malignant ObstructionJournal of Urology, VOL. 181, NO. 1, (392-396), Online publication date: 1-Jan-2009. Volume 159Issue 1January 1998Page: 179-181 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information John S. Liu More articles by this author Ronald L. Hrebinko More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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