Self-expanding permanent endoluminal stents in the ureter: technical considerations

Herein, we report our experience with the use of self-expanding permanent endoluminal stents in the ureter. To date, we have placed endoluminal stents in 55 ureteral strictures (40 patients) caused by extrinsic ureteral obstruction in advanced cancer patients over a period of 4 years at Wels Medical Center in Austria. In an additional five patients, an endoluminal stent was utilized to treat benign ureteral strictures. In the group with malignant ureteral obstruction, extended follow-up data (range 1-44 months) are available. Median primary patency, which is patency maintained without any subsequent interventions, in all patients still alive is 23.2 months (range 6-44 months). Median overall assisted patency in all patients who required further interventions is 12.7 months (range 1-37 months). Twenty-seven patients (49%) needed additional procedures (i.e., placement of an additional overlapping wallstent or internal ureteral stent, endoscopic removal of tumor ingrowth, and removal of incrustations). While the experience with endoluminal stents in the treatment of benign ureteral strictures is still limited, they are an effective tool in the clinical management of patients with malignant obstruction. However, it must be emphasized that only strict adherence to a technically correct method of implantation will yield a successful clinical outcome.