title: Complications after polymeric and metallic ureteral stent placements including three types of fistula.
abstract: OBJECTIVE
  To report complications, including three types of fistula, intractable hematuria, and pain, which can develop after polymeric ureteral stent (PUS) or metallic ureteral stent placements and to evaluate the risk factors for these adverse events.
  
  
  METHODS
  We reviewed seven patients referred to our trauma and reconstructive subdivision for complications that presented after placement of a PUS (two patients), double-layered, coated, self-expandable, mesh metallic stent (three patients), Memokath stent (one patient), or Resonance stent (one patient). We retrospectively reviewed their medical records and accessed the predisposing factors, mechanism of injury, diagnosis, and interventional and surgical management.
  
  
  RESULTS
  The two patients with PUS presented with ureteroarterial fistula (UAF). Among patients with a self-expandable metallic mesh stents, UAF developed UAF in one patient, ureteroenteral fistula (UEF) developed in one patient, and ureterovaginal fistula (UVF) developed in one patient. There were five patients with fistula who had a history of pelvic surgery, radiation therapy, long-term ureteral stent, or high-pressure balloon dilation. Surgical procedures were needed to manage these problems, including nephrectomy in two patients and bypass surgery with ureter ligation in two patients. UAF was seen with massive gross hematuria that necessitated angiography. UEF required small bowel resection. The patient with UVF underwent multiple surgeries for recurrent fistula. Patients with a Memokath or Resonance stent presented with intractable flank pain and hematuria. These persons required a surgical or other procedure to remove the stents.
  
  
  CONCLUSIONS
  UAF should be highly suspected in patients with long-term ureteral stents, especially if gross hematuria develops. The placement of a metallic ureteral stent using a high-pressure balloon should be performed cautiously, especially in patients with a history of pelvic surgery or radiation.
authors.affiliation: 1 Department of Urology, Kangwon National University Hospital , Chuncheon, Kangwon, Korea.
authors.forename: Geehyun
authors.initials: G
authors.lastname: Song
authors.forename: Bumjin
authors.initials: B
authors.lastname: Lim
authors.forename: Kyung-Sik
authors.initials: KS
authors.lastname: Han
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Song
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Park
authors.forename: Bumsik
authors.initials: B
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D005402:Fistula / Q000453:epidemiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000453:epidemiology*; D008297:Male; D008670:Metals; D008875:Middle Aged; D011108:Polymers; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D014515:Ureteral Diseases / Q000150:complications / Q000453:epidemiology; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy; D014548:Urinary Fistula / Q000150:complications / Q000453:epidemiology*; D014624:Vaginal Fistula / Q000453:epidemiology*; D016157:Vascular Fistula / Q000150:complications / Q000453:epidemiology*
chemical_list: D008670:Metals; D011108:Polymers