Allium Ureteric Stent in the Management of Iatrogenic Ureteric Injuries Causing Urine Leakage
BAUS ePoster online library. Shaw M. 06/21/21; 319119; p8-10
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Mr. Matthew Shaw
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Abstract
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Introduction
Iatrogenic ureteric injury is an uncommon but devastating injury that can occur in pelvic and abdominal operations. Urine leakage causes fistula formation and life-threatening infection. The Allium stent (AS) is a polymer-covered metallic stent. This makes it water-tight and offers the potential to occlude the defect while ureteric healing takes place. Placement of an AS is a simple endoluminal procedure.
Patients and Methods
Patients undergoing placement of AS were recorded in a prospective database. We identified patients treated between 2015 and 2020 who had an iatrogenic ureteric injury, resulting in urine leakage identified on CT scan.
Results
Fourteen patients were identified with a mean age of 63.6 years (44-78) of whom 11 were female. Aetiology of the leak was colorectal surgery (7), Gynaecology (4), renal transplant (2) and ureteroileal anastomotic leak (1). The injury was a mean 2.8cm in length (range 1-10cm). In 6 patients the AS was placed after failure of JJ stent, in 6 after failure of nephrostomy and in 2 Allium was the primary diversion mechanism. One patient suffered an adverse event within 30 days of placement of the stent, that patient died from progression of cancer.
The Allium stent remained for a mean 9 months (1 – 23). In all patients the leak stopped (100%). In 7 patients a stricture was identified at the site of the ureteric injury upon removal of the stent.
Conclusion
AS provide a safe and effective means of excluding a urine leak, allowing ureteric healing.
Iatrogenic ureteric injury is an uncommon but devastating injury that can occur in pelvic and abdominal operations. Urine leakage causes fistula formation and life-threatening infection. The Allium stent (AS) is a polymer-covered metallic stent. This makes it water-tight and offers the potential to occlude the defect while ureteric healing takes place. Placement of an AS is a simple endoluminal procedure.
Patients and Methods
Patients undergoing placement of AS were recorded in a prospective database. We identified patients treated between 2015 and 2020 who had an iatrogenic ureteric injury, resulting in urine leakage identified on CT scan.
Results
Fourteen patients were identified with a mean age of 63.6 years (44-78) of whom 11 were female. Aetiology of the leak was colorectal surgery (7), Gynaecology (4), renal transplant (2) and ureteroileal anastomotic leak (1). The injury was a mean 2.8cm in length (range 1-10cm). In 6 patients the AS was placed after failure of JJ stent, in 6 after failure of nephrostomy and in 2 Allium was the primary diversion mechanism. One patient suffered an adverse event within 30 days of placement of the stent, that patient died from progression of cancer.
The Allium stent remained for a mean 9 months (1 – 23). In all patients the leak stopped (100%). In 7 patients a stricture was identified at the site of the ureteric injury upon removal of the stent.
Conclusion
AS provide a safe and effective means of excluding a urine leak, allowing ureteric healing.
Introduction
Iatrogenic ureteric injury is an uncommon but devastating injury that can occur in pelvic and abdominal operations. Urine leakage causes fistula formation and life-threatening infection. The Allium stent (AS) is a polymer-covered metallic stent. This makes it water-tight and offers the potential to occlude the defect while ureteric healing takes place. Placement of an AS is a simple endoluminal procedure.
Patients and Methods
Patients undergoing placement of AS were recorded in a prospective database. We identified patients treated between 2015 and 2020 who had an iatrogenic ureteric injury, resulting in urine leakage identified on CT scan.
Results
Fourteen patients were identified with a mean age of 63.6 years (44-78) of whom 11 were female. Aetiology of the leak was colorectal surgery (7), Gynaecology (4), renal transplant (2) and ureteroileal anastomotic leak (1). The injury was a mean 2.8cm in length (range 1-10cm). In 6 patients the AS was placed after failure of JJ stent, in 6 after failure of nephrostomy and in 2 Allium was the primary diversion mechanism. One patient suffered an adverse event within 30 days of placement of the stent, that patient died from progression of cancer.
The Allium stent remained for a mean 9 months (1 – 23). In all patients the leak stopped (100%). In 7 patients a stricture was identified at the site of the ureteric injury upon removal of the stent.
Conclusion
AS provide a safe and effective means of excluding a urine leak, allowing ureteric healing.
Iatrogenic ureteric injury is an uncommon but devastating injury that can occur in pelvic and abdominal operations. Urine leakage causes fistula formation and life-threatening infection. The Allium stent (AS) is a polymer-covered metallic stent. This makes it water-tight and offers the potential to occlude the defect while ureteric healing takes place. Placement of an AS is a simple endoluminal procedure.
Patients and Methods
Patients undergoing placement of AS were recorded in a prospective database. We identified patients treated between 2015 and 2020 who had an iatrogenic ureteric injury, resulting in urine leakage identified on CT scan.
Results
Fourteen patients were identified with a mean age of 63.6 years (44-78) of whom 11 were female. Aetiology of the leak was colorectal surgery (7), Gynaecology (4), renal transplant (2) and ureteroileal anastomotic leak (1). The injury was a mean 2.8cm in length (range 1-10cm). In 6 patients the AS was placed after failure of JJ stent, in 6 after failure of nephrostomy and in 2 Allium was the primary diversion mechanism. One patient suffered an adverse event within 30 days of placement of the stent, that patient died from progression of cancer.
The Allium stent remained for a mean 9 months (1 – 23). In all patients the leak stopped (100%). In 7 patients a stricture was identified at the site of the ureteric injury upon removal of the stent.
Conclusion
AS provide a safe and effective means of excluding a urine leak, allowing ureteric healing.
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