V9-14: Placement of metallic ureteral stents - antegrade, retrograde and urinary diversion approaches.
VideoIntroductions and Objectives
Metallic ureteral stents are placed in patients with ureteral obstruction when long-term urinary drainage must be ensured. We demonstrate three cases highlighting the alternative placement choices with Resonance stents.
Placement through urinary diversions is demonstrated in a young female patient with a history of bladder exstrophy and the creation of a cutaneous ureterostomy. Frequent obstructions of the left ureter required the use of a long-term ureteral stent. Once the ureter is catheterized, a stiff wire is advanced to the pelvis. The insertion catheter is then advanced to the pelvis, and through it the the stent is placed. Proper placement of the stent is ascertained by the radioopaque markings on the introduction sheath. As the introduction sheath is removed, the stent coils in the pelvis and remains in place. Retrograde transurethral insertion is the the most common method of metallic stent insertion. We demonstrate the simultaneous bilateral placement of two Resonance stents in a patient with extrinsic ureteral compression due to advanced ovarian cancer. After inserting stiff guidewires through the ureters into the renal pelvises, both introduction sheaths are advanced simultaneously. Proper placement is confirmed with the radioopaque markers, and the stents are then also simultaneously inserted on both sides. The introduction sheaths are removed carefully, ensuring the formation of the distal and proximal stent coils in the bladder and pelvis respectively. The Resonance stent may also be placed percutaneously in an antegrade fashion. Upon gaining percutaneous access into the collecting system, a stiff guide wire is advanced to the bladder. The introducing sheath is placed over the wire and the stent is then placed through the sheath. As the sheath is removed, the stent is seen to coil in the bladder and in the renal pelvis, ensuring its permanence in the ureter.
Resonance stents have been successful in managing ureteral obstruction, and have been used in a variety of indications. Metallic ureteral stents are well tolerated by patients, require infrequent changes (at 12 months) and provide a solution to the need for long-term urinary drainage. We demonstrate that placement of the stents is feasible in a variety of patients, with satisfactory results.
Ureteral metallic stents may be placed through various approaches: through urinary diversions, retrogradely and anterogradely. Proper placement of the stents is important to ensure their proper function and to minimize discomfort for patients.