Ureteropelvic junction obstruction: an innovative approach combining metallic stenting and virtual endoscopy.
OBJECTIVE
We report our experience with auto-expandable metallic stents for treating ureteropelvic junction obstruction.


METHODS
We treated 4 patients with a mean age of 45 years who had ureteropelvic junction obstruction with placement of a self-expandable intraureteral metallic stent (Wallstent, Schneider, Zurich, Switzerland). All patients presented with recurrent ureteropelvic junction obstruction after open pyeloplasty. Excretory urography and 3-dimensional reconstruction computerized tomography were performed 1 and 6 months after stent insertion. Virtual endoscopy images were obtained at followup due to the need to define ureteral patency.


RESULTS
Mean followup was 16 months (range 9 to 24). Wallstent placement was successful and immediate patency was achieved in all cases. During followup 3 patients required no further intervention and the stented ureteropelvic junction remained patent. In the remaining patient stricture recurred 2 months after initial stent insertion due to the ingrowth of scar tissue through the prosthesis. Additional intervention was deemed necessary after placing a longer 6 cm., completely coaxial overlapping metal stent. Virtual endoscopy and excretory urography findings concurred. Virtual endoscopy allows visualization of the stented ureteropelvic junction lumen cephalad and caudal to the prosthesis. It also enables easy navigation within the stent at different angles of view.


CONCLUSIONS
The concept of applying metallic stents for ureteropelvic junction obstruction and adjacent adynamic ureteral segments combined with virtual endoscopy is strengthened by the results of this study.
Barbalias
George A
GA
Department of Urology, University of Patras, School of Medicine, Greece.
Liatsikos
Evangelos N
EN
Kagadis
George C
GC
Karnabatidis
Dimitrios
D
Kalogeropoulou
Christina
C
Nikiforidis
George
G
Siablis
Dimitrios
D
D000328:Adult; D004724:Endoscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D008670:Metals; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000000981:diagnostic imaging; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D014584:User-Computer Interface
D008670:Metals