Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study

Ghassen Tlili, Houssem Ammar, Sonia Dziri, Khaled Ben Ahmed, Waad Farhat, Sofiene Arem, Emir Acacha, Rahul Gupta, Arib Rguez, Mehdi Jaidane, Ghassen Tlili, Houssem Ammar, Sonia Dziri, Khaled Ben Ahmed, Waad Farhat, Sofiene Arem, Emir Acacha, Rahul Gupta, Arib Rguez, Mehdi Jaidane

Abstract

Background: Ureteral double- J stent is usually inserted by retrograde approach to treating obstructed upper urinary tract. The antegrade approach, can be suitable alternative in certain situations without general or spinal anesthesia. The present study demonstrates the indications, success rate, and complications of this approach in treatmenting malignant obstructive uropathy.

Methods: Data of consecutive patients with malignant obstructive uropathy who underwent antegrade ureteral stenting in the Department of Interventional Radiology at Sahloul hospital from January 2013 to February 2020 was retrieved and retrospectively analyzed.

Result: A total of 188 attempts of antegrade ureteral stent insertion was performed during the study period (left side = 78, right side = 82, bilateral = 14). The mean age was 54 years (range: 9-91 years). The indication of the antegrade stenting was the failure of retrograde approach in 63 patients.The single-stage approach was performed 103 times. A percutaneous nephrostomy was placed for the average duration of 22.4 days (range: 2-60 days) for subsequent attempts. Only four patients required general anesthesia. Ureteral obstruction was caused by bladder cancer (n = 92), uterine cancer (n = 31), prostate cancer (n = 28), colorectal cancer (n = 15) and retroperitoneal tumor (n = 8). A protective nephrostomy was left in situ in 44 cases for 48 h. Clinical success was achieved in 96% of the cases. Two and three patients required hospitalization for perirenal abscess and hematuria, respectively.

Conclusion: This retrospective study shows that antegrade ureteral stent insertion has a high success rate with minimal complications.

Trial registration: ClinicalTrials.gov Identifier: NCT04649970. Registered december 2, 2020- Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04649970.

Keywords: Antegrade double-J stent; Malignant obstructive uropathy; Urology.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Antegrade insertion of a JJ ureteral stent. (A) A 0.035-inch guidewire is inserted into the renal pelvis. (B) Catheterisation of the ureter into the urinary bladder with a hydrophilic guidewire and a 4 or 5 French catheter. (C) Confirmation of catheter position in the urinary bladder using radiopaque contrast material.
Fig. 2
Fig. 2
(A) abdominal CT scan showing right hydronephrosis secondary to pelvic invasion by a colorectal cancer. (C, D): Antegrade insertion of a JJ ureteral stent.

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Source: PubMed

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