ArticlePDF Available

Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

DOI:10.4103/0971-9261.91078
Authors:
Sivasankar Jayakumar at Prashanth Women & Childrens Hospital
Sivasankar Jayakumar
  • Prashanth Women & Childrens Hospital
Mohamed Marjan
Mohamed Marjan
Mohamed Marjan
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Key Wong
Key Wong
Key Wong
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Amman Bolia Bolia at University Hospitals Of Leicester NHS Trust
Amman Bolia Bolia
Show all 5 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

Proximal migration of the ureteric double J stent is a rare but known complication. We describe three cases where a minimally invasive technique for retrieval of displaced double J stents using Amplatz(™) goose-neck snare was successful. A retrospective review of patients with displaced double J stent was carried out, in whom cystoscopy guided retrieval of double J stent was attempted with the help of Amplatz goose-neck snare under radiological control. All three patients were under the age of 3 years. Two patients had migrated double J stent following pyeloplasty and in one patient the double J stent was displaced during a retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent was successfully achieved using Amplatz goose-neck snare. There were no postoperative complications. Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children.
Figures - uploaded by Sivasankar Jayakumar
Author content
All figure content in this area was uploaded by Sivasankar Jayakumar
Content may be subject to copyright.
Content uploaded by Sivasankar Jayakumar
Author content
All content in this area was uploaded by Sivasankar Jayakumar on Sep 05, 2017
Content may be subject to copyright.
6 Journal of Indian Association of Pediatric Surgeons / Jan-Mar 2012 / Vol 17 / Issue 1
INTRODUCTION
Insertion of double J (JJ) stent is common in pediatric
urology practice. Complications of ureteric stents
include stone formation, encrustation, fragmentation
of stent, fistula and migration of stent. Proximal
migration of the ureteric stent is a rare but a known
complication.[1,2] Various methods of retrieval of
stent have been described in adults,[2-5] but these are
technically more challenging in children and infants
due to the small anatomical caliber. We describe a
series of three patients under the age of 3 years, where
we demonstrate a minimally invasive technique for
retrieval of displaced double J stent using Amplatz™
goose-neck snare under radiological control.
MATERIALS AND METHODS
A retrospective review over a period of 5 years from 2000
to 2005 at our institution was carried out to identify
Original Article
ABSTRACT
Purpose: Proximal migration of the ureteric double J stent is a rare but known
complication. We describe three cases where a minimally invasive technique for
retrieval of displaced double J stents using Amplatz™ goose-neck snare was successful.
Materials and Methods: A retrospective review of patients with displaced double J stent
was carried out, in whom cystoscopy guided retrieval of double J stent was attempted
with the help of Amplatz goose-neck snare under radiological control. Results: All
three patients were under the age of 3 years. Two patients had migrated double J stent
following pyeloplasty and in one patient the double J stent was displaced during a
retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent
was successfully achieved using Amplatz goose-neck snare. There were no postoperative
complications. Conclusion: Our method of retrieval of stent from renal pelvis is simple,
safe and minimally invasive. This technique is a useful and safe alternative option for
retrieval of proximally migrated double J stents in children.
KEY WORDS: Amplatz goose-neck snare, migrated double J stent, proximal migration of
ureteric stent
Retrieval of proximally migrated double J ureteric stents in
children using goose neck snare
Sivasankar Jayakumar, Mohamed Marjan, Key Wong, Amman Bolia1, George K. Ninan
Departments of Paediatric Urology and 1Interventional Radiology, Leicester Royal Infirmary, University Hospitals
Leicester, Leicester, LE1 5WW, United Kingdom
Address for correspondence: Dr. George K. Ninan, Department of Paediatric Urology, Leicester Royal Infirmary, Infirmary Road,
Leicester LE1 5WW, United Kingdom. E-mail: georgeninen@googlemail.com
proximal migration of double J stents in pediatric
patients. A total of three patients were identified and
Amplatz goose-neck snare under radiological control
was used to retrieve the proximally migrated double J
stents in all the three cases.
Equipment
An 8-F 30° cystoscope was used for the retrieval of
double J stents in all the three patients. Amplatz goose-
neck snare of appropriate size was used with the help
of a 0.035 guide wire. Standard fluoroscopy machine
that allowed screening, Digital Subtraction Angiography
(DSA) and road map facilities were used for all the three
procedures. The radiation dose, whilst not measured
exactly in each individual patient, was minimal,
involving screening for a minute or two in total, and a
single radiograph was taken for records.
Technique
The patient is positioned as for cystoscopy under general
Access this article online
Access this article online
Website:
Website: www.jiaps.com
DOI
DOI: 10.4103/0971-9261.91078
Quick Response Code
Quick Response Code:
[Downloaded free from http://www.jiaps.com on Tuesday, September 5, 2017, IP: 103.71.214.13]
7Journal of Indian Association of Pediatric Surgeons / Jan-Mar 2012 / Vol 17 / Issue 1
Jayakumar, et al.: Migrated double J ureteric stents in children
anesthesia and an 8-F 30° cystoscope is introduced into
the bladder. A 0.035 guide wire is introduced via the
cystoscope into the appropriate ureteric orifice and the
position checked with fluoroscopy. The cystoscope is
removed and replaced by a catheter that comes with
the Amplatz goose-neck snare. The catheter is placed
adjacent to the double J stent and an appropriate size
Amplatz goose-neck snare is introduced through the
catheter under fluoroscopy control. The snare is then
pushed against the stent and deployed and twisted
in order to engage the double J stent. Once the snare
is engaged with the stent, the catheter along with the
snare and the held double J stent are removed urethrally
whilst screening, confirming that the engagement is
maintained all the time [Figure 1].
RESULTS
There were three pediatric patients. It is our practice
to remove the ureteric stent 8 weeks following
pyeloplasty via a cystoscope. In two cases, migration
of double J stent was noted at the time of cystoscopy
for elective removal of the stent following pyeloplasty.
In one of these two cases, ureteroscopy and stent
retrieval was attempted at the time of detection of
stent migration, however, without success. In the third
case, the patient had a pyeloplasty 2 years back and
underwent a retrograde insertion of the double J stent
for persistent hydronephrosis. The stent was displaced
proximally during retrograde insertion of double J
stent. In all the three cases, an Amplatz goose-neck
snare under radiological control was used to retrieve
the proximally migrated double J stents. The patient
characteristics are displayed in Table 1. There were no
postoperative complications noted. The average total
time of procedure spent under general anesthesia in
the operating room was 20 minutes.
DISCUSSION
Dislodgement and migration of double J ureteric stents
are rare but known complications. Distally migrated
stents into the urinary bladder can be easily removed
using forceps with cystoscopy guidance. However, the
difficulty arises when the stent migrates proximally.
In a comparison study, the stent-to-ureter length ratio
was lower in the migrated than in the non-migrated
group of patients with ureteric stents, suggesting that
shorter ureteric stents predisposed stent migration
proximally. The incidence of ureteric stents migrating
proximally is quoted as 2%.[2] A shorter than ideal stent,
inadequate distal curl and a proximal curl in the upper
calyx appear to be significant factors in the process of
stent migration.[6]
It is important to reposition or remove a proximally
migrated stent as it may cause obstruction or poor
drainage to the urinary flow. This can be achieved either
by an invasive procedure opening the renal pelvis or via
less invasive methods. Numerous methods of retrieval
of ureteric stents have been described in the literature.
Among these methods, ureteroscopy with the use of
grasping forceps, helical basket and ureteral balloon
dilator tip have been described in adults.[3-5] In a study
on 37 adult patients, ureteroscopy has been used to
retrieve the stents with a 91.9% success rate and no
complications.[7] Although flexible ureteroscopy has
been shown to be a safe and effective modality in the
treatment of upper ureteral calculi, with a 90% success
rate in children,[8] use of flexible ureteroscopy for stent
retrieval in children is yet to be reported. Ureteroscopy
and retrieval of proximal stent might be feasible in
children, but it may be difficult in young children and
infants due to the small anatomical caliber of the ureter.
Fluoroscopy guided retrieval of proximally migrated
ureteric stents is an alternative option to ureteroscopy.
Under fluoroscopic guidance, an antegrade approach
for the removal of such stents via pre-existing non-
Table 1: Case features
Sex Primary procedure Method of JJ
stent insertion
Age at JJ stent
retrieval (months)
Cystoscope
size used (F)
Amplax goose-neck
snare size used (mm)
Case 1 M Retrograde insertion of JJ stent Retrograde 30 8 30
Case 2 M Pyeloplasty Antegrade 8 8 20
Case 3 F Pyeloplasty Antegrade 2 8 10
Figure 1: (a) Dislodged stent and Amplatz goose-neck snare in dilated
renal pelvis. (b) The Amplatz goose-neck snare is deployed to retrieve
the dislodged stent
ab
[Downloaded free from http://www.jiaps.com on Tuesday, September 5, 2017, IP: 103.71.214.13]
8 Journal of Indian Association of Pediatric Surgeons / Jan-Mar 2012 / Vol 17 / Issue 1
dilated nephrostomy routes has been described.[9]
However, most studies in literature have described a
retrograde approach.[10,11] Use of goose-neck snare under
fluoroscopy guidance for migrated stent retrieval is a
straightforward, well-tolerated, minimally invasive
retrograde technique described in adults.[10] However,
our series represents the only study describing the
retrieval of stent from renal pelvis in children using
Amplatz goose-neck snare.
In our small series of three pediatric patients, the
proximally migrated double J ureteric stents were
successfully retrieved using the Amplatz goose-neck
snare under fluoroscopy guidance. The technique is
simple, minimally invasive with minimal radiation
exposure. The patients in our series were very young
at 2, 8 and 30 months of age, and in our experience,
ureteroscopic retrieval of migrated double J stent in
one child was unsuccessful and we attribute this to the
small anatomical caliber of ureter in young children.
We believe that this technique with Amplatz goose-
neck snare is a safe and alternative option for retrieval
of proximally migrated double J stents in infants and
young children.
REFERENCES
1. Collier MD, Jerkins GR, Noe HN, Soloway MS. Proximal stent
displacement as complication of pigtail ureteral stent. Urology
Jayakumar, et al.: Migrated double J ureteric stents in children
1979;13:372-5.
2. Breau RH, Norman RW. Optimal prevention and management
of proximal ureteral stent migration and remigration. J Urol
2001;166:890-3.
3. Meeks JJ, Helfand BT, Thaxton CS, Nadler RB. Retrieval of
migrated ureteral stents by coaxial cannulation with a flexible
ureteroscope and paired helical basket. J Endourol 2008;22:927-9.
4. Menezes P, Gujral S, Elves A, Timoney A. Ureteroscopic retrieval
of proximally displaced ureteric stents using triradiate grasping
forceps. Br J Urol 1998;81:758-9.
5. Yap RL, Batler RA, Kube D, Smith ND. Retrieval of migrated
ureteral stent by intussusception of ureteral balloon dilator tip.
Urology 2004;63:571-3.
6. Slaton JW, Kropp KA. Proximal ureteral stent migration: An
avoidable complication? J Urol 1996;155:58-61.
7. Livadas KE, Varkarakis IM, Skolarikos A, Karagiotis E, Alivizatos
G, Sofras F, et al. Ureteroscopic removal of mildly migrated stents
using local anesthesia only. J Urol 2007;178:1998-2001.
8. Nerli RB, Patil SM, Guntaka AK, Hiremath MB. Flexible
ureteroscopy for upper ureteral calculi in children. J Endourol
2011;25:579-82.
9. Shin JH, Yoon HK, Ko GY, Sung KB, Song HY, Choi E, et al.
Percutaneous antegrade removal of double J ureteral stents via
a 9-F nephrostomy route. J Vasc Interv Radiol 2007;18:1156-61.
10. Wetton CW, Gedroyc WM. Retrograde radiological retrieval and
replacement of double-J ureteric stents. Clin Radiol 1995;50:
562-5.
11. Boardman P, Cowan NC. Technical report: Fluoroscopically
guided retrograde ureteric stent retrieval and replacement using
a guide catheter directed snare. Clin Radiol 1997;52:308-9.
Cite this article as: Jayakumar S, Marjan M, Wong K, Bolia A, Ninan
GK. Retrieval of proximally migrated double J ureteric stents in children
using goose neck snare. J Indian Assoc Pediatr Surg 2012;17:6-8.
Source of Support: Nil, Confl ict of Interest: None declared.
Announcement
Android App
A free application to browse and search the journal’s content is now available for Android based
mobiles and devices. The application provides “Table of Contents” of the latest issues, which
are stored on the device for future offline browsing. Internet connection is required to access the
back issues and search facility. The application is compatible with all the versions of Android. The
application can be downloaded from https://market.android.com/details?id=comm.app.medknow.
For suggestions and comments do write back to us.
[Downloaded free from http://www.jiaps.com on Tuesday, September 5, 2017, IP: 103.71.214.13]
... Conventionally retrograde cystoscopic route is the preferred route for removal of these stents [2,3]. However, the conventional method of retrograde cystoscopic stent removal may not be feasible in presence of proximal stent migration, distorted anatomy secondary to PEDIATRIC UROLOGY CASE REPORTS ISSN 2148-2969 urinary diversion or previous bladder surgeries [2][3][4]. Antegrade percutaneous nephrostomic removal of the ureter stent can be used as a bailout technique in these cases and is well described in the literature [2][3][4]. However, our case was unique as it was performed in an infant which required certain modifications in standard technique. ...
... However, the conventional method of retrograde cystoscopic stent removal may not be feasible in presence of proximal stent migration, distorted anatomy secondary to PEDIATRIC UROLOGY CASE REPORTS ISSN 2148-2969 urinary diversion or previous bladder surgeries [2][3][4]. Antegrade percutaneous nephrostomic removal of the ureter stent can be used as a bailout technique in these cases and is well described in the literature [2][3][4]. However, our case was unique as it was performed in an infant which required certain modifications in standard technique. ...
... Percutaneous antegrade nephrostomic removal of ureteral stent is well described in literature and generally considered a safe procedure despite few reported complications like nephrostomy wound infection, pelvicalyceal system injury, and clot in renal pelvis [2][3][4][5][6][7]. Major studies in this regard have described the use of 8F or 9F vascular access sheath placed through a percutaneous nephrostomic route and removal of the DJ stent using micro-snares or foreign body removal forceps [2,3,6]. ...
Removal of proximally migrated double J ureteric stent through a percutaneous nephrostomy route in an infant
Article
Full-text available
  • Jul 2020
Proximal migration of double J-stent (DJ stent) can be a reason for failure of its cystoscopic removal. Antegrade percutaneous nephrostomic removal of the stent can be done in such cases. Although the technique is described in adults and older children, the technique requires some modification when used in infants because of smaller calibre of pelvicalyceal system. Here we describe a case of a 6 month old male child who was treated by robotic assisted pyeloplasty for left sided ureteropelvic junction obstruction followed by placement of DJ stent. Cystoscopic removal of the stent 6 weeks after surgery was not possible due to proximal migration of the stent. Hence, antegrade percutaneous nephrostomic removal of the stent was performed using micro-snare. Certain novel technical modifications, like advancement of a diagnostic angiographic catheter in pelvicalyceal system, has been used in this case to reduce the risk of urothelial injury. Thus, antegrade removal of DJ stent with few technical modifications can be used safely in infants for removal of proximally migrated stents.
... Hence, its repositioning or removal is warranted. Literature has described different approaches such as ureteroscopy with the forceps, basket, and ureteral dilators [17][18][19][20]. In an analysis of 37 patients, the retrieval of the stents was performed using ureteroscopy with a 91.9% success rate [21]. ...
Ureteral stent complications - experience on 50,000 procedures
Article
Full-text available
  • Nov 2021
Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks - 34,213 procedures), respectively long-term stenting (more than 6 weeks - 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.
... Managing stent migration in pediatric patients is a more challenging process than in adults. Several methods for resolving this problem have been reported [12,13] . The most common, and most disturbing, complication is ureteral stent-dependent complaints. ...
Non-Invasive Stent Removal after Ureteroneocystostomy in Pediatric Patients: Long- Term Results
Article
Full-text available
Objective: Among the more serious problems in urological interventions among the pediatric age group is the requirement of general anesthesia. The advantages of removing a double-J stent (DJS) without anesthesia in ureteroneocystostomy (UNC) operations among children were investigated in this study. Patients and methods: In all, 25 patients who underwent UNC surgery between November 2016 and November 2018 were retrospectively divided into two groups according to the method used for the removal of the DJS. In Group 1, the stent was tied to the urethral catheter by a suture and retrieved postoperatively on the fourth day without anesthesia and cystoscopy. In Group 2, we inserted the stent according to the classical method with no suturing to the catheter and removed it 3 to 4 weeks after the first operation, with cystoscopy under anesthesia. Results: A total of 16 girls and 9 boys were included in the study. The mean age was 4.3 and 6.3 years in groups 1 and 2, respectively. We did not observe statistically significant difference between the groups in long-term renal function or hydronephrosis regression. Conclusion: We consider that the removal of a stent placed in pediatric intravesical UNC operations without anesthesia and cystoscopy is less invasive and affords safety and long-term results comparable to the standard method.
... Although placement of a ureteral stent is easy, serious complications may occur during or after such a procedure (5)(6)(7)(8)(9). ...
An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report
Article
Full-text available
  • Apr 2016
Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.
The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES): A novel technique for the intraureteric assembly of a loop snare for the retrograde extraction of a migrated ureteric stent
Article
  • Mar 2022
Background While ureteric stent removal remains a frequently performed endourological procedure stent migration either proximally or distally can present the endourologist with a significant intraoperative dilemma. In cases where the stent is of large calibre or impacted into the mucosa of the ureter, retrieval may prove refractory to traditional approaches. Objective To present a further novel procedure: The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES) which allows for intraureteric assembly of a tightening loop through a ureteric catheter thus permitting safe retrieval of a migrated stent. Methods We describe the procedure as it was performed and have recreated the steps in a laboratory environment. This demonstrates an adaptation of existing materials readily found in most urological theatres and is not a prototypical device. Results The procedure was successfully performed to allow extraction of the migrated ureteric stent. Conclusion WHISTLES is a reproducible method for the retrieval of migrated ureteric stents where traditional techniques have failed. Level of evidence 5
Management of proximal migration of double-J stents after Anderson-Hynes pyeloplasty in children
Article
Extended summary Introduction Proximal migration of double J stents after pediatric pyeloplasty is rare. Although retrograde removal of migrated stents is more common, the small calibre of the pediatric ureter may necessitate antegrade retrieval. Many techniques are described for the same in adults however, pediatric literature is sparse. We aim to describe the management of proximally displaced stents after pediatric pyeloplasty. Materials and methods his retrospective study included all children (<17 years age) who underwent retrieval of proximally displaced DJ stents after pyeloplasty between 2007 and 2019 at a single institution. The retrograde technique employed ureteroscopic retrieval with a grasper while in the antegrade technique, an access sheath was placed percutaneously into a calyx and Nephroscopic retrieval was performed. Results There were 8 children (6 boys and 2 girls) of which 4 were infants. Median age was 3.5 (0.5-12) years and median follow-up was 7.5 (4-47) months. Two children had been referred with displaced stents after pyeloplasty from other centres. The incidence of proximal stent migration was 6/1644 (0.4%). Open pyeloplasty had been performed in seven while one child had undergone laparoscopic pyeloplasty. The lower coil of the migrated stent was in the renal pelvis in 6 (complete) and ureter in 2 (partial migration). Those with partial migration underwent successful ureteroscopic retrieval. Three infants required Antegrade stent removal while ureteroscopic retrieval was successful in an older child with complete stent migration. Nephrectomy for loss of function and redo pyeloplasty for pelvi-ureteric stricture was performed in one each. One child had self-limiting fever (Clavien 1) after stent removal. All had normal drainage on renogram after 6 months. The cause of proximal stent migration was likely to be an inadequate lower coil (<180◦) in 5 children and a capacious pelvis with narrow ureter in one infant. The cause could not be ascertained in two children who were referred from other centres. The management algorithm for retrieval of proximally migrated DJ stents, is depicted in figure 3. Conclusions Proximal migration of DJ stent after pyeloplasty is a rare complication which may be safely managed with a stepwise approach using both Antegrade and retrograde techniques. Accurate stent length, adequate distal coil and appropriate placement are essential to avoid stent migration.
Tips and Tricks for Difficult Ureteral Stent Insertion
Chapter
  • Nov 2017
Stents are widely used in urology to relieve obstruction or bypass strictures. In order to simplify stent insertion in difficult situations it is essential to have a wide range of endourological equipment available including guidewires, ureteric catheters, rigid and flexible ureteroscopes, ureteral dilatation equipment including serial and balloon dilators, baskets, ureteric access sheaths, various stent types and sizes and an image intensifier. An excellent assistant, scrub nurse and theater staff who are familiar with endourological equipment and techniques is also vital. In cases were a retrograde approach fails an antegrade approach should be attempted.
Preclinical Evaluation of a Newly Designed Ureteral Stent and Magnetic Retrieval Catheter for Minimally Invasive Stent Removal
Article
Objective: To develop a simple minimally invasive method for ureteral stent removal that does not require cystoscopy or fluoroscopic guidance. Materials and methods: We developed a novel ureteral stent comprising the main body of a stent and an iron oxide-coated net that was woven of processed polyester sutures. The ureteral stent was retrieved by a magnetic retrieval catheter with small hooks on the neck surface. Detailed analysis of the necessary mechanical and magnetic properties was performed, and we conducted retrieval tests of the ureteral stent from a specially designed urinary system model. Results: The breaking strength and Young modulus of the processed polyester sutures were 10.12 ± 0.30 N and 9143 ± 7 N/tex, respectively. Thermogravimetric tests showed that the iron (III) oxide powders on the processed sutures accounted for 23% of the total weight. The magnetization value of the magnetic retrieval catheter was 578 emu/g. The dissolution times of polyvinyl alcohol wrapped the net in saline or urine were 24.2 ± 2.0 and 23.6 ± 3.1 hours, respectively. All stents in both the experimental and the control groups were successfully removed from the specially designed urinary model. However, the retrieval time in the experimental group was significantly shorter than that in the control group (38.6 ± 12.6 vs 59 ± 15.7 seconds; P <.05). Conclusion: Ureteral stent removal using a magnetic retrieval catheter with small capture devices is considered feasible. This technique is easy to learn and should be considered as suitable for use on an outpatient basis.
Stents and stone disease
Article
  • Jun 2013
The use of stents in renal stone disease is relatively new. The main advantage is reduced pressure in the renal collecting system during times of infected obstructed collecting systems, surgery or obstructing stones. As much pain relieve theses stents offer when indicated, equally much morbidity is caused when stent materials interface with the human urothelium in terms of symptoms, perforations and the "forgotten stent". This review aim to summarize some of the most important considerations when stents are used in stone disease.
Flexible Ureteroscopy for Upper Ureteral Calculi in Children
Article
Full-text available
Ureteroscopy is one of the therapeutic options in the management of urinary stone disease in children. Previous literature has described ureteroscopy primarily in mid to distal ureteral calculi. We report our experience with flexible ureteroscopy in the management of upper ureteral calculi. All children with upper ureteral stones were included prospectively in the study. Stone burden was measured in millimeters. Presentation, operative access, intraoperative complications, stone-free rates, and postoperative complications were evaluated. A total of 80 children (69 boys and 11 girls) underwent 88 ureteroscopic procedures. In 72 (90%) children, complete stone clearance was achieved after a single ureteroscopic session. In 6 (7.5%) others, complete stone clearance was achieved after the second ureteroscopic session. Complete stone clearance after single ureteroscopy is possible if the calculi are single, small (<10 mm), and below the level of the pelviureteral junction.
Proximal stent displacement as complication of pigtail ureteral stent
Article
The indwelling ureteral stent recently introduced by Cook offers relative ease of placement with a self-curling end which prevents migration down the ureter. We have seen 4 cases of proximal migration of these stents. The reasons for this event are described. Our experience suggests the placement of a suture in the distal portion of the catheter to allow retrieval of the catheter should migration occur.
Proximal Ureteral Stent Migration: An Avoidable Complication?
Article
  • Feb 1996
The parameters responsible for proximal ureteral stent migration were quantitated. We compared 16 patients seen between 1990 and 1993 with stent migration to 32 patients whose stents did not migrate. The stent indwelling time and number of stents with a proximal curl of less than 180 degrees were similar between the groups. More patients with migration had stents that were shorter than the ideal length, with a distal curl of less than 180 degrees and a proximal curl in the upper calix versus the renal pelvis. A shorter than ideal stent, inadequate distal curl and a proximal curl in the upper calix appear to be significant factors in the process of stent migration.
Retrograde radiologic retrieval and replacement of double-J ureteric stents
Article
Internal double-J stents are used to maintain ureteral patency and require replacement within 4-6 months. We present our experience with 15 consecutive patients who had 35 internal ureteral stents retrieved and in whom 27 were successfully replaced, retrogradely under fluoroscopic control. The double-J stents were retrieved using an Amplatz gooseneck snare. Replacement was more successful in female patients, and was technically more difficult via an ileal conduit or transplant ureter. We found this new technique to be straightforward and well tolerated by the patients. The procedure was performed on an outpatient basis, and no serious complications were reported. This technique is considerably cheaper than cystoscopic replacement under epidural or general anaesthesia, and is recommended for the retrieval and replacement of internal ureteral plastic stents in most patients.
Technical report: Fluoroscopically guided retrograde ureteric stent retrieval and replacement using a guide catheter directed snare
Article
Double pigtail ureteric stent placement is an established treatment for ureteric obstruction. Regular stent replacement, to prevent blockage secondary to encrustation, is most commonly performed cystoscopically, but fluoroscopic or ultrasound guided retrograde replacement are alternative methods. Fluoroscopically guided retrograde stent replacement using a guide catheter directed snare is described. The snare consists of a 0.035' moveable core guide-wire with the central core removed. This is formed into a loop and passed through an 8 F guide catheter. The procedure is performed in the interventional radiology suite under light sedation, The technique is simple, fast, effective and safe. The system is atraumatic to the bladder and urethra and provides an inexpensive alternative to purpose built snares.
Ureteroscopic retrieval of proximally displaced ureteric stents using triradiate grasping forceps
Article
Re: Optimal prevention and management of proximal ureteral stent migration and remigration [6]
Article
  • Sep 2001
We evaluated issues associated with proximal ureteral stent migration and remigration, including causes and management, and the predictability of ureteral length. All proximal ureteral stent migrations that occurred from January 1997 to March 2000 were reviewed. Characteristics and treatment of the 33 patients with proximal ureteral stent migration were compared with those of 66 randomly selected controls who did not have stent migration. We also analyzed a subgroup of 6 cases of remigration. Of the ureteral stents 2% migrated proximally. Mean height was greater in patients with versus without a migrated stent (p = 0.028). The stent-to-ureter length ratio was lower in the migrated than in the nonmigrated group (p <0.0001). Patient height and side of migration were significant predictors of ureteral length (R2 = 0.3511, p <0.0001 and 0.0007, respectively). Of the patients who required continued ureteral stenting migrated stent management included placement of a longer stent in 9 (group 1) and a stent of equal length in 4 (group 2), and repositioning of the original stent in 4 (group 3). There was no remigration in group 1. However, migration recurred in 2 patients in group 2 (50%) and in all 4 in group 3 (100%). Proximal migration occurs when a stent is too short for the ureter. We recommend that ureteral length should be measured directly from an x-ray to select the optimal stent length. If it is necessary to continue stenting a ureter after migration has been detected, a longer stent should be placed.
Retrieval of migrated ureteral stent by intussusception of ureteral balloon dilator tip
Article
  • Apr 2004
A vexing complication of ureteral stent placement is inadvertent proximal migration. The retrieval of a migrated ureteral stent may be performed using a myriad of techniques but usually requires ureteroscopic extraction. We report a novel, time-efficient technique to capture and reposition a migrated ureteral stent without ureteroscopic manipulation.
Percutaneous Antegrade Removal of Double J Ureteral Stents via a 9-F Nephrostomy Route
Article
To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral stents via preexisting nondilated nephrostomy routes under fluoroscopic guidance. Under fluoroscopic guidance and local anesthesia, antegrade removal of 39 ureteral stents in 27 patients was attempted by using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n = 8), a surgical history resulting in an inaccessible retrograde route (n = 8), urethral stricture (n = 5), upward stent migration (n = 2), inability to obtain a lithotomy position (n = 1), fragmentation of the proximal stent (n = 1), and inability to find the ureteral orifice with a cystoscope (n = 2). Thirty-seven of the 39 stents (95%) were successfully removed by using a snare or basket. Two stents (5.1%) could not be removed with a snare or basket because they were embedded against the renal calyx or pelvis. There were no major complications. Blood clot formation or laceration or tract leakage of the pelvicalyceal system occurred in six and two patients, respectively, all of which resolved spontaneously. Percutaneous antegrade removal of double J ureteral stents with a snare or basket via a nondilated nephrostomy route is effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option.
Ureteroscopic Removal of Mildly Migrated Stents Using Local Anesthesia Only
Article
  • Nov 2007
In the outpatient office setting we evaluated the feasibility and efficacy of ureteroscopic removal of upward migrated ureteral stents using local or no anesthesia. Prospectively 37 patients with mild upward stent migration underwent ureteroscopic stent removal under local or no anesthesia. Stent migration was always below the pelvic brim. It was diagnosed by plain x-ray of the kidneys, ureters and bladder, and flexible cystoscopy. Semirigid ureteroscopy was performed in the office outpatient setting. After each procedure patients graded the discomfort and/or pain level experienced by completing 2 separate 5-scale visual analog pain scores, including 1 for flexible cystoscopy and 1 for the ureteroscopic procedure. Pain scores were compared between the 2 procedures. Stent removal was successful in 34 of 37 patients (91.9%). Successful procedures were never interrupted due to pain intolerance. No complications occurred. The mean visual analog pain score for ureteroscopic stent removal was 1.73 and it was similar in men and women (p = 0.199). The mean visual analog pain score for flexible cystoscopy was 1.27. This procedure was significantly more painful in men than in women (p = 0.018). Ureteroscopic stent removal was more painful than flexible cystoscopy overall and in women (each p <0.01) but not in men (p = 0.3). All patients were discharged home within 1 hour after the procedure and no patient required hospital admission or a new hospital visit. Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.