Management of single DJ stent failure in malignant ureteral obstruction: tandem ureteral stenting with less frequent stent exchange

İngilizce (OpenAlex)

To evaluate the safety and efficacy of the placement and exchange of tandem ureteral stents (TUS) under fluoroscopic guidance in the management of indwelling single double-J stent (DJS) failure in patients with malignant ureteral obstruction.We also aimed to investigate whether the generally accepted exchange period of DJSs could be extended using TUS. METHODSThis retrospective study involved 11 patients (10 female) with an age range of 27-64 years, median of 49 years, who underwent TUS (ipsilateral two 8F DJSs) placement due to indwelling single DJS failure occurring in less than 3 months.TUS exchanges were performed initially at 6-month intervals, and subsequent exchange intervals were extended to 9 and 12 months for seven patients.The interval from initial TUS placement to percutaneous nephrostomy, repeat exchange, or death was defined as the duration of stent patency. RESULTSIndwelling single DJS failure occurred during a median follow-up of 45 days (range, 35-60 days) in 14 ureters of 11 patients.TUS were successfully placed and exchanged with a technical success rate of 100% without any early major complications.Thirty-nine procedures (11 placement and 28 exchange procedures) in 55 ureters were performed.The median duration of urinary patency was significantly higher with TUS [300 days (range, 60-440 days)] compared with single DJSs [45 days (range, 35-60 days)] (P < 0.001). CONCLUSIONThe placement and exchange of TUS can be safely and effectively performed under fluoroscopic guidance.The need for frequent DJS exchange could be reduced with increased duration of stent patency using TUS. KEYWORDTandem ureteral stents, double-J stent, malignant ureteral obstruction, retrograde exchange, stent failure M alignant ureteral obstruction (MUO) is a common manifestation of metastatic disease and requires urinary diversion.Ureteral stenting in an antegrade or retrograde fashion is an effective and safe method of choice in such cases, offering superior quality of life compared with percutaneous nephrostomy.[1][2][3] Nevertheless, ureteral polymeric double-J stent (DJS) malfunction rates are between 19% and 58%.[4][5][6] Metal-mesh stents, metallic stents, and tandem stents (two ipsilateral DJSs) are alternative options to maintain urinary diversion and percutaneous nephrostomy in cases of single DJS malfunction.[7][8][9][10][11][12]