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Abstract
Introduction: Urinary tract obstruction is a common clinical entity which can progress to acute pyelonephritis and even life - threatening septic shock. Retrograde drainage using JJ catheter placement has been traditionally a standard treatment. However, this procedure might be challenging or even failure due to malignant obstruction or large compacted ureteral stones. Percutaneous nephrostomy (PCN) and pigtail drainage catheter insertion is a safe and effective alternative to failed retrograde JJ stent. The shortcomings of PCN are risk of infection, urine leakage and inconvenience given the existence of an external drainage catheter. Antegrade JJ insertion is an advanced step of PCN which covers advantages of both classic retrograde JJ catheter and PCN. We aimed to evaluate the preliminary result of antegrade JJ stent insertion at Hue University of Medicine and Pharmacy hospital.
Methods: Data of 5 patients (male/female 1/4, age range 49 - 76 years) with urinary tract obstruction who underwent antegrade JJ stent insertion from 8/2019 - 8/2022 were retrospectively analyzed. Antegrade JJ stent placement was indicated after failed retrograde approach. Local anesthesia was applied in all cases and the procedures were performed under ultrasound and fluoroscopic guidance with the use of the standard technique of PCN. A 0.035” hydrophilic wire was manipulated to cross the obstructed site to the bladder, then a stiff wire was exchanged. Predilation using a low - pressure balloon was performed, when
necessary, followed by the insertion of a 7F JJ catheter, 20 cm in length. Technical success was defined as the correct positioning of the stent within the urinary tract. Clinical success was defined as the patients’ clinical status at discharge. The study endpoint was at discharge.
Results: 8 JJ stents were inserted antegradely in 5 patients. All patients had elevated serum creatinine and hydronephrosis grade I - II on CT urography. 2 patients had ureteral compacted stones, 1 had extensive bladder cancer, 1 had extensive prostatic cancer and 1 had progressive cervical cancer. Technical success rate was 100% without intra and post - procedural complications. All patients were stable at discharge and were scheduled for further treatment (operation or oncological therapy).
Conclusion: Percutaneous antegrade JJ stent placement is safe and effective for the management of urinary tract obstruction and can be considered a bailout procedure after failed retrograde attempt.
References
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| Published | 06-01-2025 | |
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| Issue | No. 88 (2023) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.88.16 | |
| Keywords | Dẫn lưu thận qua da, sonde JJ niệu quản, tắc nghẽn đường dẫn niệu Percutaneous nephrostomy, double - J catheters, urinary tract obstruction |
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