Management of single double-J stent failure in malignant ureteral obstruction: tandem ureteral stenting with less frequent stent exchange

PURPOSETo evaluate the safety and efficacy of the placement and exchange of tandem ureteral stents (TUS) under fluoroscopic guidance in the management of indwelling single double-J stent (DJS) failure in patients with malignant ureteral obstruction. We also aimed to investigate whether the generally accepted exchange period of DJSs could be extended using TUS.METHODSThis retrospective study involved 11 patients (10 female) with an age range of 27–64 years, median of 49 years, who underwent TUS (ipsilateral two 8F DJSs) placement due to indwelling single DJS failure occurring in less than 3 months. TUS exchanges were performed initially at 6-month intervals, and subsequent exchange intervals were extended to 9 and 12 months for seven patients. The interval from initial TUS placement to percutaneous nephrostomy, repeat exchange, or death was defined as the duration of stent patency.RESULTSIndwelling single DJS failure occurred during a median follow-up of 45 days (range, 35–60 days) in 14 ureters of 11 patients. TUS were successfully placed and exchanged with a technical success rate of 100% without any early major complications. Thirty-nine procedures (11 placement and 28 exchange procedures) in 55 ureters were performed. The median duration of urinary patency was significantly higher with TUS [300 days (range, 60–440 days)] compared with single DJSs [45 days (range, 35–60 days)] (P < 0.001).CONCLUSIONThe placement and exchange of TUS can be safely and effectively performed under fluoroscopic guidance. The need for frequent DJS exchange could be reduced with increased duration of stent patency using TUS

A novel technique for the non-surgical management of inadvertent bowel catheterization during percutaneous abscess drainage: a technical note

Percutaneous abscess drainage-related inadvertent bowel catheterization is an undesired complication that requires treatment. In two cases without signs of peritonitis that we examined, it was possible to achieve successful abscess drainage, and to treat abscess-related inadvertent bowel catheterization by using a novel technique without surgery

Görüntüleme kılavuzluğunda perkütan nefrostomi: 6 yıllık tek merkez deneyimi

Aim: To retrospectively analyze the indications, underlying pathologies, technical success rate, complications and benefit of percutaneous nephrostomies in a single centre. Materials and Methods: Data of 578 patients who underwent radiologically guided percutaneous nephrostomy between January 1999 and December 2004 were retrospectively reviewed. The mean age of the patients was 42.5 years (range, 6 days–90 years). The indications were urinary obstruction without urinary infection (77.9%), urinary obstruction with urinary infection (13.1%), urinary diversion (6.9%) and diagnostic testing (2.1%). Results: The technical success rate was 99.4%. There was no procedure related mortality. Major hemorrhage or sepsis were not observed in children. Major hemorrhage occurred in 1.55% and sepsis occured in 2.65% of adult patients. Catheter dislodgement was the commonest complication with an overall rate of 11.4%. In 7.2% patients, percutaneous nephrostomy was successful in managing patients without further intervention. 36.5% of patients had surgery and 14.7% had ureteral stenting as definitive treatment. Conclusion: Radiologically guided percutaneous nephrostomy, can be used effectively, and safely in a wide variety of indications with high technical success and low complications rates.Amaç: Perkütan nefrostomilerin, endikasyonlarını, altta yatan patolojileri, teknik başarı oranını, komplikasyonları ve genel faydalarını retrospektif olarak incelemek. Materyal ve Metod: Ocak 1999 ile Aralık 2004 tarihleri arasında görüntüleme kılavuzluğunda perkütan nefrostomi yapılan 578 hastanın verileri retrospektif olarak incelenmiştir. Hastaların ortalama yaşı 42,5 yıl idi (6 gün–90 yıl). İşlem endikasyonları üriner enfeksiyon olmadan obstrüksiyon varlığı (% 77,9), üriner enfeksiyon ile beraber obstrüksiyon varlığı (%13,1), üriner diversiyon (%6,9) ve böbrek fonksiyonları değerlendirme (%2,1) idi. Bulgular: Teknik başarı oranı % 99,4 idi. İşlemle ilişkili mortalite izlenmedi. Çocuklarda major hemoraji ya da sepsis görülmemişti. Erişkin hastalarda major kanama oranı % 1,55, sepsis oranı ise %2,65 idi. Kateter dislokasyonu en sık ortaya çıkan komplikasyondu ve oranı toplamda %11,4 idi. Hastaların %7,2'sinde başka girişim yapılmadan perkütan nefrostomi ile başarılı tedavi sağlandı. Hastaların %36,5'inde cerrahi ile ve %14,7'sinde ise üreteral stent yerleştirilerek kesin tedavi sağlandı. Sonuç: Radyoloji kılavuzluğunda yapılan perkütan nefrostomi, yüksek teknik başarı ve düşük komplikasyon oranları ile çok çeşitli endikasyonlarda etkili ve güvenli bir şekilde kullanılabilir

Pyelolymphatic Backflow Demonstrated By An Abdominal Ct: A Case Report

Background Pyelolymphatic backflow phenomenon, which is a subtype of pyelorenal backflow, is a rare condition that occurs during the acute phase of urinary obstruction. Pyelorenal backflow has already been described in humans with retrograde pyelography. Our report presents a rare case of pyelolyphatic backflow demonstrated by a computed tomography. Case Report A 67-year-old man with a history of bladder carcinoma was admitted to the emergency department due to right-sided flank pain and hematuria. Hematuria resolved after insertion of a 3-way urinary catheter, but flank pain persisted. As a result, an abdominopelvic CT was performed. CT revealed numerous tiny, serpiginous tubular structures connected with each other and filled with urine. They began intrarenally and extended caudally surrounding the ureter in the retroperitoneum. Subsequently, the patient underwent an ultrasound-guided nephrostomy to decompress the collecting system of the right kidney. Antegrade pyelography revealed minimal hydroneprosis. However, no leakage from the ureter to the retroperitoneum was observed, proving that the changes demonstrated by a CT were due to pyelolymphatic reflux caused by increased pressure in the collecting tubules filling the lymphatics with opaque urine. Conclusions This report presents a very rare case of pyelolymphatic reflux demonstrated by a CT. We present this case report as a reminder that although rare, pyelolymphatic reflux can occur as a result of obstruction without manifestations of hydronephrosis and it can be confused with leakage from the ureter.PubMe