Antegrade ureteral stenting for dehiscence, strictures, and fistulae

Percutaneous placement of ureteral stents is advocated as an attractive alternative to surgical procedures in the management of some ureteral dehiscence, strictures, and inflammatory ureteral fistulae. In 50 patients with partial dehiscence or fistulae, a stent could be placed percutaneously in 41. The method achieved a salvage rate of renal function (30 cases [60%]) similar to that of open surgical correction. Hospitalization time and costs, however, were far less. The method proved particularly successful (nine of 10 cases) for correction of pelvic ureters severed from the bladder during pelvic surgery, dehiscence of ureteroneocystostomies into boari flaps, and traumatic severance of the upper and mid ureters. The method is also highly recommended for the management of strictures occurring at ureteroileostomy sites and at the ureteroneocystostomy site of cadaver transplant kidneys. Although the ultimate salvage of renal function is lower than in the above-described conditions, the relative ease of placing percutaneous stent catheters across such strictures in comparison with highly complex surgical salvage procedures necessary to correct these conditions makes the former the first choice.