title: One-stage tubeless antegrade ureteric stenting: a safe and cost-effective option?
abstract: BACKGROUND
  Antegrade insertion of ureteric stent has become an established mode of management of upper tract obstruction secondary to ureteric pathology. It is conventionally performed as a two-stage procedure for various reasons but, more recently, a one-stage approach has been adopted.
  
  
  METHODS
  We discuss our experience of primary one-stage insertion of antegrade ureteric stent as a safe and cost-effective option for the management of these difficult cases in this retrospective observational case cohort study of patients referred to a radiology department for decompression of obstructed upper tracts. Data were retrieved from case notes and a radiology database for patients undergoing one-stage and two-stage antegrade stenting. It was followed by telephone survey of regional centres about the prevalent local practice for antegrade stenting. Outcome measures like hospital stay, procedural costs, requirement of analgesia/antimicrobials and complication rates were compared for the two approaches.
  
  
  RESULTS
  a one-stage approach was found to be suitable in most cases with many advantages over the two-stage approach with comparable or better outcomes at lower costs. Some of the limitations of the study were retrospective data collection, more than one radiologist performing stenting procedures and non-availability of interventional radiologist falsely raising the incidence of two-stage procedures.
  
  
  CONCLUSIONS
  In the absence of any clinical contra-indications and subject to availability of an interventional radiologist's support, one-stage antegrade stenting could easily be adopted as a routine approach for the management of benign or malignant ureteric obstruction.
authors.affiliation: Department of Urology, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK. chitalenorwich@aol.com
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Chitale
authors.forename: Vaiyapuri
authors.initials: V
authors.lastname: Raja
authors.forename: Nabeel
authors.initials: N
authors.lastname: Hussain
authors.forename: Janak
authors.initials: J
authors.lastname: Saada
authors.forename: Simon
authors.initials: S
authors.lastname: Girling
authors.forename: Stuart
authors.initials: S
authors.lastname: Irving
authors.forename: J F
authors.initials: JF
authors.lastname: Cockburn
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000191:economics / Q000379:methods; D015641:Radiography, Interventional / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology / Q000601:surgery*