ANTEGRADE URETERIC STENTING IN MANAGEMENT OF URETERIC OBSTRUCTION IN CASE OF DIFFICULT RETROGRADE ACCESS; INDICATIONS, SUCCESS RATES & PREDICTORS OF FAILURE

Document Type : Original Article

Authors

1 Department of Urology, Ain Shams University, Cairo, Egypt.

2 Department of Urology, Ahmed Maher Teaching Hospital, Cairo, Egypt.

Abstract

Background: Double j (jj) routinely inserted cystoscopically in retrograde manner in managing various causes of ureteric obstruction. sometimes we face situations at which the jj failed to be inserted in such conventional route or carrying high degree of difficulty. antegrade jj can be successful alternative modality in managing such failures/ difficulties.
Aim of the work: Evaluate the antegrade ureteric stenting as an alternative to the retrograde ureteric stenting in the difficult cases of ureteric obstruction and to evaluate the predictors of success/failure of this procedure
Patients & Methods: Prospective non-blinded interventional study that is conducted from the department of urology faculty of medicine Ain Shams University, Cairo, Egypt, between 2016 till 2020. included 78 patients with different causes of ureteric obstruction in two groups; group(I) included 28 patients with ureteric obstruction who had failed retrograde ureteric stenting; for them antegrade jj stenting were tried & group (II) included 50 cases of ureteric obstruction with high probability of difficulty or failure of retrograde stenting for them retrograde jj stenting tried first in 34 cases & if failed retrograde stenting were tried, while antegrade stenting tried directly in 16 patients due to high patients vulnerability.
Results: In patients of group(I) antegrade stenting succeeded in 26 (92.86) patients & failed in 2 (7.14) patients.in group (II) retrograde trial succeeded in (7) cases & antegrade tried in (43) cases (27 cases after retrograde trial failure & 16 cases tried from the start), antegrade stenting succeeded in 39 (90.7%) cases & failed in 4(9.3%) cases. dye study e.g flow of dye to bladder showed statistically significant predictor of success/failure in both groups. most prevalent complications were hematuria in group(I) in (57 %) of the studied cases(hemoglobin drop didn’t exceed 1 gm /dl & hematuria subsided with genera measures) while in group (II) no complications occurred in (44%) of cases. nephrostomy tube needed in(21%) of cases in group (I) & needed in (38%) of cases in group(II)
Conclusion: Antegrade ureteric stenting is successful alternative in cases of failure of conventional retrograde stenting & show high success rate in cases of high probability of difficulties.

Keywords

Ain Shams Medical Journal
Volume 72, Issue 3
September 2021
Pages 465-477

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