Recent Advances in Ureteral Stents

Chan Park; Ji Hoon Shin

doi:10.3348/jksr.2019.80.4.631

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Park and Shin: Recent Advances in Ureteral Stents

Review Article

J Korean Soc Radiol 2019;80(4):631-642.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.4.631

Recent Advances in Ureteral Stents

Chan Park, MD, Ji Hoon Shin, MD^∗

Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^∗Corresponding author Ji Hoon Shin, MD Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel 82-2-3010-4400 Fax 82-2-476-0090 E-mail jhshin@amc.seoul.kr

Received 27 March 2019 Revised 10 May 2019 Accepted 11 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A ureteral stent is widely used to drain ureteral obstructions, which allows urine to bypass the obstruction. The double J stent, a representative ureteral stent, has undergone many advancements in material and design recently. In addition, indications of double J stent insertion have been broadly expanded to improve urinary obstruction before and after extracorporeal shock wave lithotripsy and to maintain ureteral patency after a ureteral surgery or treatment of a ureteral fistula. The recently developed metallic ureteral stents showed excellent long-term patency in patients with malignant ureteral strictures. Therefore, metallic stents could be an alternative to double J stents in select patients. In this review article, we describe the materials, designs, indications, details of the antegrade ureteral stenting procedure, and outcomes of the double J stent and metallic stent procedures.

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Fig. 1.

Representative double J stents. A. Flexima ureteral stent. The proximal end of the shaft is sutured (arrowhead), with a pigtail loop in the renal pelvis. No radiopaque bands or side holes are present at the shaft. B. Percuflex ureteral stent. The proximal end of the pigtail is sutured (arrowhead). A radiopaque band (proximal shaft) and side holes are present at the shaft. C. Sof-flex ureteral stent. The proximal end of the pigtail is sutured (arrowhead). Two radiopaque bands (proximal and distal shaft) and side holes are present at the shaft.

Fig. 2.

Schema shows DJ stent insertion. A. The DJ stent is pushed into the urinary bladder using a pushing catheter. A 9 Fr sheath is usually used. B. On magnification, the suture loop (arrow) connected to the DJ stent is outside the body through the sheath. This loop is for repositioning and pigtail shaping. C. As a guidewire is out, the distal pigtail is positioned in the urinary bladder, and the proximal pigtail is positioned in the renal pelvis by manipulating the pushing catheter and suture loop. At the final position of the DJ stent, the suture loop is cut and removed. DJ = double J

Fig. 3.

A 70-year-old man who underwent radical cystectomy and neobladder formation for bladder cancer reports abrupt hematuria. A. On coronal CT, the left double J stent (arrows) inserted four months ago is noted adjacent to the left common iliac artery. B. The left common iliac angiogram shows no definite hematuria. The left renal angiogram shows no bleeding (not shown). C. The left renal pelvis irrigation through nephrostomy shows opacification of the left common iliac artery (arrows), revealing an arterioureteral fistula. The stent graft (13-mm diameter, 5-cm length) was inserted to seal off the fistula (not shown). D. The completion angiogram shows complete closure of the fistula after insertion of the stent graft (arrows). Hematuria has disappeared.

Fig. 4.

The modified snare technique to remove the DJ stent is shown. Schematic illustration (A) and fluoroscopy (B) demonstrate a spatial relationship among the snare (arrows), guidewire (arrowheads), and DJ stent. After the guidewire winds around the DJ stent, it is snared to create a loop around the DJ stent. Subsequently, the entire assembly, including the DJ stent, guidewire, and snare-guiding sheath, is withdrawn through the sheath (inset in B). DJ = double J

Fig. 5.

A 70-year-old man with advanced gastric cancer reports left hydronephrosis. A. Antegrade pyelogram via percutaneous nephrostomy tube shows multifocal, segmental ureteric strictures (arrows) from middle to distal ureter. B. The first stent (arrows) is inserted to cover the middle to distal ureter, following a 7-mm balloon dilation of the entire ureter. C. The second stent (arrows) is inserted to cover the proximal to middle ureter, followed by a repeated 7-mm balloon dilation (arrowheads). D. The antegrade pyelogram two days following metallic ureteral stent placements shows good flow of the contrast medium through metallic ureteral stents into the urinary bladder.

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