Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters
Failure of retrograde approach for ureteric stenting warrants percutaneous nephrostomy with antergrade stenting to relieve the pressure symptoms and prevent the need for external drainage. However, in some tight ureteric strictures with grossly dilated tortuous ureter it may not be possible to navig...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2020-08-01
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| Series: | Journal of Clinical Interventional Radiology ISVIR |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1710165 |
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| author | Manish Kiran Shreshta Amey Narkhede Arun Gupta |
| author_facet | Manish Kiran Shreshta Amey Narkhede Arun Gupta |
| author_sort | Manish Kiran Shreshta |
| collection | DOAJ |
| description | Failure of retrograde approach for ureteric stenting warrants percutaneous nephrostomy with antergrade stenting to relieve the pressure symptoms and prevent the need for external drainage. However, in some tight ureteric strictures with grossly dilated tortuous ureter it may not be possible to navigate a ureteric stent across. In such instances pull through or rendezvous techniques have been advocated. Here, we have illustrated simple and novel techniques for traversing tortuous ureters with tight strictures. In one instance, a guide wire was snared via the perurethral approach and the system stabilized from both ends; the flexometallic sheath was then advanced into the urinary bladder across the stricture and a ureteric stent was deployed. In the other situation where the ureter was very tortuous, plain twisting and turning maneuver with retraction of whole assembly was done to straighten the ureter followed by advancement of the flexometallic sheath and stationing of the ureteric stent. In both the cases no significant procedure-related complications were seen and patients were discharged in stable condition. Our experience has led us to believe that occasionally all facilities may not be accessible immediately or the desired armamentarium may be unavailable for interventional radiologists, especially when the patient is on the table; in such cases, simple improvisation and techniques can come in handy to place a ureteric stent across a dilated tortuous ureter. |
| format | Article |
| id | doaj-art-95c2d25cb90d450fa32e2170dd23b567 |
| institution | OA Journals |
| issn | 2456-4869 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Clinical Interventional Radiology ISVIR |
| spelling | doaj-art-95c2d25cb90d450fa32e2170dd23b5672025-08-20T02:10:06ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Clinical Interventional Radiology ISVIR2456-48692020-08-0140212512910.1055/s-0040-1710165Antegrade Double-J Stenting in Grossly Dilated and Tortuous UretersManish Kiran Shreshta0Amey Narkhede1Arun Gupta2Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, IndiaDepartment of Interventional Radiology, Sir Gangaram Hospital, New Delhi, IndiaDepartment of Interventional Radiology, Sir Gangaram Hospital, New Delhi, IndiaFailure of retrograde approach for ureteric stenting warrants percutaneous nephrostomy with antergrade stenting to relieve the pressure symptoms and prevent the need for external drainage. However, in some tight ureteric strictures with grossly dilated tortuous ureter it may not be possible to navigate a ureteric stent across. In such instances pull through or rendezvous techniques have been advocated. Here, we have illustrated simple and novel techniques for traversing tortuous ureters with tight strictures. In one instance, a guide wire was snared via the perurethral approach and the system stabilized from both ends; the flexometallic sheath was then advanced into the urinary bladder across the stricture and a ureteric stent was deployed. In the other situation where the ureter was very tortuous, plain twisting and turning maneuver with retraction of whole assembly was done to straighten the ureter followed by advancement of the flexometallic sheath and stationing of the ureteric stent. In both the cases no significant procedure-related complications were seen and patients were discharged in stable condition. Our experience has led us to believe that occasionally all facilities may not be accessible immediately or the desired armamentarium may be unavailable for interventional radiologists, especially when the patient is on the table; in such cases, simple improvisation and techniques can come in handy to place a ureteric stent across a dilated tortuous ureter.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1710165antegrade stentingtortuous ureterflexometallic sheathperurethral approach |
| spellingShingle | Manish Kiran Shreshta Amey Narkhede Arun Gupta Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters Journal of Clinical Interventional Radiology ISVIR antegrade stenting tortuous ureter flexometallic sheath perurethral approach |
| title | Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters |
| title_full | Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters |
| title_fullStr | Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters |
| title_full_unstemmed | Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters |
| title_short | Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters |
| title_sort | antegrade double j stenting in grossly dilated and tortuous ureters |
| topic | antegrade stenting tortuous ureter flexometallic sheath perurethral approach |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1710165 |
| work_keys_str_mv | AT manishkiranshreshta antegradedoublejstentingingrosslydilatedandtortuousureters AT ameynarkhede antegradedoublejstentingingrosslydilatedandtortuousureters AT arungupta antegradedoublejstentingingrosslydilatedandtortuousureters |