Category: Other, Miscellaneous

VS15-3 - Allium ureteral stents: exit strategy in case of migration

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Ureteral stenoses and fistulae are currently treated by complex surgery, not always possible because of patient-specific anatomical and clinical features. In these cases, palliative maneuvers, like DJ ureteral stents or nephrostomies, are often adopted, influencing negatively patient’s quality of life. Allium ureteral stents (AUSs) represent an interesting alternative. They are self-expanding large-caliber devices, made up of nitinol and totally covered by a polymeric material to prevent tissue ingrowth. They are designed to stay inside ureter for 1 to 3 years. AUSs may be removed endoscopically unraveling it into a thread-like strip.
Our aim was to present the exit strategy adopted by our center to remove AUSs in case of migration.


Methods :

We present two patients treated with 12cm-long and 30Fr-large AUSs. The first case deals with a 47-year-old man with iatrogenic left pelvic ureteral stenosis, previously treated with a DJ ureteral stent and a nephrostomy for 3 months. The second case deals with a 51-year-old woman, who presented a left lumbar ureteral stenosis, firstly treated with the placement of a DJ ureteral stent for 7 months.


Results :

In the first case, after 7 days we removed the AUS retrogradely because of device migration above the stenotic portion. The maneuver resulted particularly challenging and delicate, as the stent should pass through the stenotic ureteral tract.
In the second case, after AUS positioning, hydronephrosis persisted in the following months and the patient suffered from recurrent urinary tract infections, likely due to stent colonization. The CT scan showed the AUS migrated into the renal pelvis, demanding a percutaneous renal access to remove it. After two days, the patient complained about low back pain and we registered anemia: the CT scan showed a renal pseudoaneurysm that required embolization.


Conclusions :

The AUS offers a valid solution for ureteral fistulae and stenoses, especially in patients not eligible for major surgery. However, it is not free from complications; among them, the possibility of migration, needing device removal. A percutaneous renal access may be required exposing patients to further complications. Therefore, an adequate patient selection is mandatory, and the treatment should be managed by expert urologists.

Gianluca Sampogna

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Paolo Zanetti

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Andrea Gallioli

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Elisa De Lorenzis

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Franco Palmisano

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Matteo Fontana

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Ilaria Sabatini

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Luzzago

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Luca Boeri

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milano, Lombardia, Italy

Luca Boeri MD, Resident in Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
I am a III year resident in Urology (chief Prof. Emanuele Montanari). I have been doing research since 4 years. My interests are in minimally invasive surgery, endourology, stone disease, infections, prostate cancer, bladder cancer and andrology.
I am currently attending a 1 year Research Fellowship at Mayo Clinic (Rochester, Minnesota, USA).
Our Department in Milan is a leading center for PCNL, RIRS, UTUC treatment, robotic surgery.

Giancarlo Albo

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Fabrizio Longo

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Emanuele Montanari

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy