Category: Endoscopic

MP21-5 - The safety and efficacy of Cook Resonance® metallic ureteric stent in the treatment of chronic obstruction: The North Wales experience

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

We evaluated the efficacy and safety of metallic ureteric stenting using the Cook Resonance® stent in the treatment of chronic ureteric obstruction, with medium-term follow up.

Methods :

All patients who had a Resonance® metallic stent inserted between April 2009 and April 2018 in our institution were identified from a prospectively maintained stent-database. Primary outcome was relief of ureteric obstruction, defined by successful clinical and radiological treatment of hydronephrosis/hydroureter. Secondary outcome measures included operative time, radiological exposure, total stent dwell time (defined as the cumulative time in months for which a Resonance® metallic stent was in situ), early and late complications.

Results :

Forty patients underwent 114 stent insertion episodes (SIE). Median age was 68 years (range 33–90). Stent insertion resulted in successful treatment of hydronephrosis/hydroureter in 91.2% (10 SIE resulted in failure to relieve ureteric obstruction). Median operative time per procedure (bilateral or unilateral) was 30 min (range 20–60) and median radiation exposure was 537.15 cGy/cm2 (range 16.55–5366). Median stent dwell time was 24 months (range 2–76) in non-malignant and 13 months (range 2–80) in malignant ureteric obstruction. One stent migrated proximally during insertion and had to be retrieved using an antegrade approach. Four patients were readmitted with post-operative urinary tract infection. Among the 4 patients, 2 developed urosepsis but recovered on treatment with IV antibiotics without need for HDU/ITU. In addition, 5 patients were re-admitted with haematuria which resolved without intervention or blood transfusion. However, four of them were later seen in clinic complaining of persistent haematuria and lower urinary tract symptoms(LUTS).

Conclusions :

Metallic ureteric stenting using the Resonance® stent is safe and effective for treating ureteric obstruction from both malignant and benign causes. The success rate in our series was 91.2% and complications were minimal.

Obinna Obi-Njoku

Speciality Registrar Urology, Wrexham Maelor Hospital NHS Wales
Membership of The Royal College of Surgeons England(MRCSeng)
WREXHAM, Wales, United Kingdom

My name Mr. Obi-Njoku Obinna Joseph, a member of the Royal College of Surgeons England and I gained my MBBS degree in 2011 from The Great University of Benin, Benin City Nigeria. I am currently a Speciality Doctor in Urology at The Wrexham Maelor Hospital NHS Wales.

Chirag Patel

Speciality Registrar, Wrexham Maelor Hospital
Wrexham, Wales, United Kingdom

Mohammad Hossain

Speciality Registrar, Wrexham Maelor Hospital NHS Wales
Wrexham, Wales, United Kingdom

Rachel Jones

Speciality Nurse, Wrexham Maelor Hospital NHS Wales
Wrexham, Wales, United Kingdom

Mohamed Yehia

Consultant Urological Surgeon
Wrexham Maelor Hospital NHS Wales, Betsi Cadwaladr University Health Board, Wrexham, Wales, United Kingdom
Wrexham, Wales, United Kingdom

Stephen Hughes

Research lead, North Wales & North West Urological Research Centre Wrexham Maelor Hospital, BCUHB, Wrexham, North Wales, UK
Wrexham, Wales, United Kingdom

Iqbal Shergill

Consultant Urological Surgeon, Wrexham Maelor Hospital NHS Wales
Betsi Cadwaladr University Health Board
Wrexham, Wales, United Kingdom

Professor Shergill qualified from Charing Cross & Westminster Medical School in 1997. During his medical student training, he carried out 1 year full-time research leading to a 1st Class BSc(Honours) degree, from the University of London. The results were presented as posters at national and international meetings. He also managed to receive academic distinctions by obtaining The Medical Research Council (MRC) Intercalated Course Award and The Nuffield Foundation Undergraduate Research Bursary. Professor Shergill completed Basic Surgical Training on the respected Oxford Rotation (1998 to 2000) and was one of the first candidates to sit and successfully pass the new MRCS examination in 2000.
Professor Shergill undertook a period of full-time research towards an MD thesis at the University of London between 2002 and 2004, prior to starting his Higher Urological Training. Professor Shergill commenced Higher Surgical Training in Urology in 2004, on the North Thames Deanery Rotation. During this time, he worked in several high-throughput specialist centres, gaining experience and training in 21st Century state-of-the art management of Urinary tract Stone disease, Laser Prostatectomy, Complex Uro-oncology disease, as well as the management of benign and malignant urological disease using Laparoscopic and Minimally Invasive surgery. During 2008, he successfully passed the final FRCS(Urol) examination, and then completed Higher Urology Training in April 2010.
Honorary Clinical Teacher – Cardiff School of Medicine
Honorary Senior Lecturer – Manchester Medical School
Honorary Senior Lecturer – University of Chester
Honorary Senior Lecturer – Bangor University
Clinical Director – North Wales and North West Urological Research Centre
Visiting Professor - Glyndwr University Wrexham