Placement of transileal conduit retrograde nephroureteral stents in patients with ureteral obstruction after cystectomy: technique and outcome.

摘要

OBJECTIVE: The objective of our article is to describe the technique, complications, and long-term results of transileal conduit retrograde nephroureteral stents placed for ureteral obstruction after radical cystectomy. MATERIALS AND METHODS: Patients with urinary diversion who presented for retrograde nephroureteral stent placement for the management of ureteral obstruction from June 1997 to August 2007 were identified via retrospective review of PACS and medical records. The procedure was performed in three stages: placement of an antegrade percutaneous nephrostomy or nephroureterostomy catheter, subsequent conversion to a transileal conduit retrograde nephroureteral stent with replacement of the antegrade nephrostomy catheter, and removal of the antegrade nephrostomy catheter after the first successful exchange of the retrograde catheter via the conduit. Medical records were reviewed to determine resolution of the signs and symptoms prompting the procedure and procedure-related complications. RESULTS: Forty-nine patients with ureteral obstruction underwent image-guided placement of 61 antegrade nephrostomy or nephroureterostomy catheters (37 unilateral, 12 bilateral) followed by attempted conversion to transileal conduit retrograde nephroureteral stents. Technical success was achieved in 56 of 61 renal units (91.8%). Clinical success, which was defined as resolution of creatinine elevation, urosepsis, and pain associated with hydronephrosis, occurred in 44 of 49 patients (89.8%) with a mean clinical follow-up of 22 months. Minor complications included tube dislodgement resulting in pericatheter leakage in two patients. No major complications occurred. Delayed complications including catheter dislodgement, recurrent urosepsis, and inability to exchange the retrograde nephroureteral stents were seen in four patients (8.2%) and were mostly due to catheter encrustation. CONCLUSION: Transileal conduit retrograde nephroureteral stent placement is safe and effective and may serve as definitive treatment for the management of postsurgical ureteral obstruction after noncontinent urinary diversion procedures.