Percutaneous Antegrade Double J Ureteral Stent placement at Kenyatta National Hospital: Indications, technical success rate, commonly encountered problems and solutions

Abstract

Background: Percutaneous ureteric stenting using image guidance is a safe method in treating obstructive ureteral pathology. Due to  the development of nephrostomy services in many hospitals, antegrade stenting has become a common procedure in the radiology  department.

Objective: This study sought to identify the indications, determine the technical success rate and identify the commonly  encountered problems and their solutions during percutaneous antegrade double J ureteral stenting at our institution.

Materials and  Methods: Data of 53 patients who underwent 55 antegrade stenting procedures was retrieved and retrospectively analyzed. Data on study variables and technique modifications to overcome the problems encountered during the procedure was collected.

Results:  Among the malignant causes of ureteral obstruction, carcinoma of the cervix was the most common, accounting for 79.17% of the  procedures. Other malignant causes included prostate cancer (9%), bladder cancer (6%), retroperitoneal carcinoma (2%), endometrial  cancer (2%) and colon cancer (2%). Benign causes of ureteral strictures included post-surgical fibrosis (42.85%, idiopathic (42.5%) and  urolithiasis (14.29%). There was high overall technical success rate of 90.91%. Common problems encountered during antegrade stenting  included dilated and tortuous ureters, (47.42%), suboptimal calyceal access (20.62%), tight ureteral obstruction (18.56%) and difficulties in  positioning the proximal pigtail loop of the ureteric stent (13.40%).

Conclusion: The most common indication for antegrade ureteral  stenting was malignant obstruction. Antegrade stenting has a high technical success rate. The most commonly encountered problem was  dilated and tortuous ureters.