Korean J Urol.  2012 Sep;53(9):625-631. 10.4111/kju.2012.53.9.625.

Palliative Care of Malignant Ureteral Obstruction with Polytetrafluoroethylene Membrane-Covered Self-Expandable Metallic Stents: Initial Experience

• Kim JH
• Song K
• Jo MK
• Park JW

• KMID: 2061701
• DOI: http://doi.org/10.4111/kju.2012.53.9.625

Abstract

PURPOSE
We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results.
MATERIALS AND METHODS
Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure.
RESULTS
The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain.
CONCLUSIONS
UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.

Keyword

Palliative care; Stents; Ureteral obstruction

MeSH Terms

Creatinine
Cystoscopy
Fluoroscopy
Follow-Up Studies
Hematuria
Humans
Hydronephrosis
Palliative Care
Polytetrafluoroethylene
Stents
Ureter
Ureteral Obstruction
Urinary Bladder
Creatinine
Polytetrafluoroethylene

Figure

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  FIG. 1 Structure of the polytetrafluoroethylene membrane-covered self-expandable metallic (UVENTA) stents. (A) Both ends are fully covered with polytetrafluoroethylene membrane. (B) The flexibility of the UVENTA stent is shown. (C) The 2 metallic meshes (outer & inner) with the polytetrafluoroethylene membrane between them. (D) Cystoscopic view of the UVENTA stent after deployment in the trans-uretero-vesical junction. (E) Components of the inner sheath.

• 

  FIG. 2 Steps for insertion of polytetrafluoroethylene membrane-covered self-expandable metallic (UVENTA) stents. (A) Using retrograde pyelography, the length, shape, and level of stricture in the left upper ureter are identified. (B) The obstructed ureter is dilated by using a balloon dilator before UVENTA stent insertion. (C) The UVENTA stent is deployed. Note that 2 stents are sequentially inserted with overlapping ends in order to cover a long stricture.

• 

  FIG. 3 Intravenous urography before and 4 weeks after polytetrafluoroethylene membrane-covered self-expandable metallic (UVENTA) stent insertion to treat a right lower ureter obstruction due to local recurrence of right colon cancer. (A) Before UVENTA insertion. Note hydronephrosis in right kidney despite the double-J stent. (B) Four weeks after UVENTA insertion. The 8 cm-long UVENTA stent is in the right lower ureter. Hydronephrosis is no longer observed.

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