The use of Allium ureteric stents in the treatment of ureteric obstruction or injury.
BAUS ePoster online library. Rogers A. 06/23/21; 319052; p14-4
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Alistair Rogers
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Abstract
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Introduction
Ureteric obstruction can occur due to many causes such as cancer and iatrogenic injury. Drainage via JJ ureteric stenting can be sufficient, but in a significant number of patients this strategy is ineffective, leading to stent occlusion risking renal failure or sepsis. The Allium ureteric stent is a polymer-covered metallic stent which may provide alternative drainage in certain circumstances.
Methods
All patients undergoing placement of an Allium stent were recorded in a prospective database. 68 patients had placement of a stent in 79 renal units between 2015 and 2020 for ureteric obstruction, injury or leak. Insertion was performed; retrogradely(n=60), antegradely(n=3) and via rendezvous(n=5).
Results
Indications for insertion were (n=renal unit); Iatrogenic ureteric leaks (15) and Obstructive strictures (64). Obstruction was due to malignancy in 19 and benign conditions in 45. 6 patients had renal transplants and 2 had ileal conduits. Treatment was successful in 58(72%) renal units, defined as maintained renal drainage or healed leak when in situ or removed. Treatment failed in 21(28%) units due to obstruction above/below stent, stent migration or failure to tolerate stent symptoms. Stent migration occurred in 17 (21%) renal units, with benign pathology(13) and proximal location(8) risk factors for migration.
Conclusions
Endourological management of complex ureteric pathology can be challenging. This largest series to date of Allium stent experience shows they work well where other means of renal drainage have failed and reduce need for long term nephrostomy. Migration rate is similar to some other series of metallic stents and requires further investigation.
Ureteric obstruction can occur due to many causes such as cancer and iatrogenic injury. Drainage via JJ ureteric stenting can be sufficient, but in a significant number of patients this strategy is ineffective, leading to stent occlusion risking renal failure or sepsis. The Allium ureteric stent is a polymer-covered metallic stent which may provide alternative drainage in certain circumstances.
Methods
All patients undergoing placement of an Allium stent were recorded in a prospective database. 68 patients had placement of a stent in 79 renal units between 2015 and 2020 for ureteric obstruction, injury or leak. Insertion was performed; retrogradely(n=60), antegradely(n=3) and via rendezvous(n=5).
Results
Indications for insertion were (n=renal unit); Iatrogenic ureteric leaks (15) and Obstructive strictures (64). Obstruction was due to malignancy in 19 and benign conditions in 45. 6 patients had renal transplants and 2 had ileal conduits. Treatment was successful in 58(72%) renal units, defined as maintained renal drainage or healed leak when in situ or removed. Treatment failed in 21(28%) units due to obstruction above/below stent, stent migration or failure to tolerate stent symptoms. Stent migration occurred in 17 (21%) renal units, with benign pathology(13) and proximal location(8) risk factors for migration.
Conclusions
Endourological management of complex ureteric pathology can be challenging. This largest series to date of Allium stent experience shows they work well where other means of renal drainage have failed and reduce need for long term nephrostomy. Migration rate is similar to some other series of metallic stents and requires further investigation.
Introduction
Ureteric obstruction can occur due to many causes such as cancer and iatrogenic injury. Drainage via JJ ureteric stenting can be sufficient, but in a significant number of patients this strategy is ineffective, leading to stent occlusion risking renal failure or sepsis. The Allium ureteric stent is a polymer-covered metallic stent which may provide alternative drainage in certain circumstances.
Methods
All patients undergoing placement of an Allium stent were recorded in a prospective database. 68 patients had placement of a stent in 79 renal units between 2015 and 2020 for ureteric obstruction, injury or leak. Insertion was performed; retrogradely(n=60), antegradely(n=3) and via rendezvous(n=5).
Results
Indications for insertion were (n=renal unit); Iatrogenic ureteric leaks (15) and Obstructive strictures (64). Obstruction was due to malignancy in 19 and benign conditions in 45. 6 patients had renal transplants and 2 had ileal conduits. Treatment was successful in 58(72%) renal units, defined as maintained renal drainage or healed leak when in situ or removed. Treatment failed in 21(28%) units due to obstruction above/below stent, stent migration or failure to tolerate stent symptoms. Stent migration occurred in 17 (21%) renal units, with benign pathology(13) and proximal location(8) risk factors for migration.
Conclusions
Endourological management of complex ureteric pathology can be challenging. This largest series to date of Allium stent experience shows they work well where other means of renal drainage have failed and reduce need for long term nephrostomy. Migration rate is similar to some other series of metallic stents and requires further investigation.
Ureteric obstruction can occur due to many causes such as cancer and iatrogenic injury. Drainage via JJ ureteric stenting can be sufficient, but in a significant number of patients this strategy is ineffective, leading to stent occlusion risking renal failure or sepsis. The Allium ureteric stent is a polymer-covered metallic stent which may provide alternative drainage in certain circumstances.
Methods
All patients undergoing placement of an Allium stent were recorded in a prospective database. 68 patients had placement of a stent in 79 renal units between 2015 and 2020 for ureteric obstruction, injury or leak. Insertion was performed; retrogradely(n=60), antegradely(n=3) and via rendezvous(n=5).
Results
Indications for insertion were (n=renal unit); Iatrogenic ureteric leaks (15) and Obstructive strictures (64). Obstruction was due to malignancy in 19 and benign conditions in 45. 6 patients had renal transplants and 2 had ileal conduits. Treatment was successful in 58(72%) renal units, defined as maintained renal drainage or healed leak when in situ or removed. Treatment failed in 21(28%) units due to obstruction above/below stent, stent migration or failure to tolerate stent symptoms. Stent migration occurred in 17 (21%) renal units, with benign pathology(13) and proximal location(8) risk factors for migration.
Conclusions
Endourological management of complex ureteric pathology can be challenging. This largest series to date of Allium stent experience shows they work well where other means of renal drainage have failed and reduce need for long term nephrostomy. Migration rate is similar to some other series of metallic stents and requires further investigation.
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