Stent obstruction
not obstructed obstructed
1,6 1,4 1,2 1 0,8 0,6 0,2 0 IPSS score: mean value, only urgency/frequency symptoms VAS: mean value
* Images courtesy of Dipartimento di Scienze dei Materiali e Ingenieria Chimica - Politecnico di Torino (Italia)
A*
PATIENTS 22 patients: 10 M, 12 F Average age 64 yrs Mean Follow up 16 Months
RESULTS Intraoperative complications: 0/22 Postoperative complications: 0/22 Technical problems or retro-migration of the stent: 0/22
Introduction: Placing temporary stents for the treatment of ureteral obstruction is a common procedure. This study, however, examined the possibility of using permanent metallic stents in those patients with ureteral strictures or extrinsic ureteral compression due to a carcinoma. Material & Methods: Twenty-two (22) patients with high grade hydronephrosis due to ureteral obstruction were treated. The patient cohort consisted of patients who had ureteral strictures or extrinsic compression caused by carcinomas. 6Fr metallic ureteral stents (Resonance™, Cook Medical, Limerick, Ireland), placed via a retrograde approach, were used. Pre- and post-voiding abdominal ultrasound was performed after 24 hours and 3 months in order to evaluate hydronephrosis and/or vesico-ureteral reflux. Patient toleration of the stent was assessed using a specific questionnaire, Visual Analog Score (VAS) and International Prostate Symptom Score (IPSS); furthermore, intraoperative/postoperative complications and urinary infections were also recorded. Results: Current mean follow-up is 16 months. No intraoperative or postoperative complications were recorded. In particular, no technical problems or retro-migrations of the stents were observed. Urinary infections were also absent. In 2 out of 22 cases (9%) stent obstructions with consequent hydronephrosis were observed, having been diagnosed with ultrasound. In these cases, the stent was easily removed and substituted. Patient toleration was very good in 17 out of 22 (77%) patients, good for 4 out of 22 (18%) and poor in only 1 (5%) case. The VAS score was 1 or 2 for all patients and mean IPSS (regarding urgency/frequency) symptoms was 1.5. Conclusion: On the basis of this preliminary experience, we must conclude that the Resonance™ metallic stent is an effective method of resolving ureteral obstructions and is well tolerated by patients. This, therefore, represents a viable alternative to traditional permanent stents.
B*
Very good
SIDE Left: 6 Right: 6 Bilateral: 10
Tolerability
Good Poor VAS IPSS SCORE
INDICATIONS Electron Microscopy: Resonance™ Stent before use, where the coiled structure of the catheter is shown. (a) Central part of the stent (b) Edge of the pigtail. Ureteral strictures, stones hypotonic ureter: 7 Extrinsic compression: 15
AORTIC INTERVENTION
CARDIOLOGY
CRITICAL CARE
ENDOSCOPY
PERIPHERAL INTERVENTION
SURGERY
UROLOGY
WOMEN’S HEALTH
Resonance-Cauda Article.indd 2
16/01/2008 14:32:24
Initial Experience with the use of Metallic Stents for the treatment of Ureteral Obstructions
F. Cauda, V. Cauda*, C.Fiori, L. Squintone
Dipartmento di Nefrourolgia, Ospedale Molinette - Torino (Italia) / *Dipartimento di Scienze dei Materiali e Ingenieria Chimica - Politecnico di Torino (Italia)
AORTIC INTERVENTION
CARDIOLOGY
CRITICAL CARE
ENDOSCOPY
PERIPHERAL INTERVENGY
WOMEN’S HEALTH
Resonance-Cauda Article.indd 1
16/01/2008 14:32:24