Direct primary or secondary percutaneous ureteral stenting: what is the most compliant option in patients with malignant ureteral obstructions?
The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting (637 euros; SD, 115 euros) was significantly higher than that of procedures which involved direct or primary stenting (560 euros; SD, 108 euros). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.
Carrafiello
Gianpaolo
G
Radiology Department, University of Insubria, Varese, Italy. gcarraf@tin.it
Laganà
Domenico
D
Lumia
Domenico
D
Giorgianni
Andrea
A
Mangini
Monica
M
Santoro
Domenico
D
Cuffari
Salvatore
S
Marconi
Alberto
A
Novario
Raffaele
R
Fugazzola
Carlo
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000191:economics; D018579:Patient Selection; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D014567:Urography