Factors Predicting Success Rate Of Retrograde Ureteric Stenting In Managing Patients With Ureteric Obstruction- Our Experiences In A South Indian Tertiary Institute

摘要

Objectives: To analyze various factors predicting success of retrograde ureteric stenting in managing patients with ureteric obstruction.Methods: Between June 2010 and December 2011, 30 consecutive patients with ureteral obstruction including 11 bilateral cases were evaluated in our prospective study.All cases of ureteric obstruction in which surgical intervention is required were included. However, bladder tumor obstructing bilateral ureteric orifices, previous cystectomy and diversion cases, iatrogenic trauma to ureter, renal transplant, pregnant women, carcinoma cervix infiltrating both ureteric orifices and trigone, medically unfit patients were excluded. In addition, extrinsic compression cases, congenital causes and ureteral strictures were also excluded. Failures in retrograde ureteral stenting were immediately treated with percutaneous nephrostomy.Data such as age, sex, stone size, degree of hydronephrosis, creatinine values were analyzed using Chi-square test with Yates correction for statistical significance.Results: There is statistical significant association between stone size and failure rate (P-value = 0.0014). In addition, there is a stronger association between degree of hydronephrosis and failure rate (P-value = 0.0014). Creatinine is normalized in 100% of unilateral cases and 78% of bilateral cases after 3 months. In the rest of bilateral cases, the creatinine values were significantly improved to near normal values.Conclusion: There is a 95% success rate with retrograde ureteral stenting for intrinsic ureteral decompression. Severe hydronephrosis, large stone (>2cm), bilateral stones and patients presented with high creatinine levels were identified as predictors of failure with the stent. This study further strengthens the importance of prompt treatment of intrinsic ureteral obstruction patients with retrograde ureteral stent placement for early and prompt restoration of renal function. Introduction Obstructed ureter is an emergency warranting urgent surgical decompression. In recent years, Double-J stenting has gained popularity among urologists for urgent decompression of ureters. The alternative options available for urologists for decompression of ureters include external diversion by percutaneous nephrostomy. Selection of urgent decompression of ureters procedure is a debatable topic and is left to the surgeon’s preference. In this prospective study, we attempt to analyze the factors predicting success of retrograde ureteric stenting in managing patients with ureteric obstruction. Materials And Methods In this prospective study, we included 30 consecutive patients admitted to urology admissions unit, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati with ureteral obstruction including 11 bilateral cases between June 2010 and December 2011. Listed below are the inclusion and exclusion criteria used.Inclusion criteria All cases of ureteric obstruction in which surgical intervention is required were included.Exclusion criteria Patients with the following complications are exclude in this study.Bladder tumor obstructing both ureteric orifices.Patients with previous cystectomy and diversion procedures.Iatrogenic trauma to ureter.Renal transplant patientsPregnant womenCarcinoma cervix infiltrating both ureteric orifices and trigone.Medically unfit patients.Other causes of extrinsic compressionCongenital causes.Ureteral stricturesThis study is cleared by SVIMS institutional ethical committee, IEC-162, dated-2-11-2011. A written informed consent is obtained from all the patients included in study.Detailed history, clinical examination is done and following investigations are carried out like renal function tests, urine analysis, plain X-ray KUB and ultrasound abdomen. Non contrast CT scan abdomen was performed in cases where standard evaluation is not satisfactory.Severity of hydronephrosis is graded on ultrasound as mild, moderate and severe. Patients with ureteral obstruction associated with