Tandem ureteral stenting

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Abstract

Ureteral stricture is a common urological problem, which has a high recurrence rate. The efficiency of treatment is affected not only by the etiology of the stricture, its length, the technique of the surgical procedure (open, endoscopic, laparoscopic, robot-assisted), but also the method and duration of ureteral drainage in the postoperative period. Classical approach using one internal stent does not provide optimal ureteral lumen at the site of intervention, while special stents for endopyelotomy (with larger segment at the area of stricture) can lead to ischemia and prevent adequate urodynamics. The insertion of two internal stents (tandem stenting) allows to achieve adequate urine passage due to the so-called "useful" space between the stents and the natural ureteral lumen, a low probability of ischemia due to the absence of circular pressure on the stricture area, as well as a sufficient diameter to maintain the internal lumen. In this article, publications devoted to tandem ureteral stenting are reviewed and our own results are presented.

Tandem ureteral stenting is an effective and safe method and, in the future, can expand the possibilities of minimally invasive treatment of patients with ureteral strictures.

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About the authors

A. B. Mantcaev

A.I. Burnazyan SRC FMBC, FMBA of Russia; FGBU National Medical Research Center of Higher Medical Technologies – CBKG named after A.A. Vishnevskyi of the Ministry of Defense of Russia

Email: alexandrmantsaev@gmail.com

Ph.D. student Department of Urology and Andrology, urologist

Russian Federation, Moscow; c. Krasnogorsk

A. G. Martov

A.I. Burnazyan SRC FMBC, FMBA of Russia; Medical Scientific and Educational Center of Lomonosov Moscow State University; FBU "Central Clinical Hospital of Civil Aviation"

Author for correspondence.
Email: martovalex@mail.ru
ORCID iD: 0000-0001-6324-6110

corresponding member of RAS, Ph.D., MD, Professor, Head of the Department of Urology and Andrology, leading researcher at the Department of Urology and Andrology of Medical Scientific and Educational Center, Chief of Urologic Center

Russian Federation, Moscow; Moscow; Moscow

A. S. Andronov

A.I. Burnazyan SRC FMBC, FMBA of Russia; FBU "Central Clinical Hospital of Civil Aviation"

Email: dr.andronov@mail.ru

Ph.D., Head of the Department of Urology, associate professor at the Department of Urology and Andrology

Russian Federation, Moscow; Moscow

S. S. Serikov

A.I. Burnazyan SRC FMBC, FMBA of Russia

Email: stanislavserikov1@gmail.com
ORCID iD: 0000-0002-3180-7291

second-year resident at the Department of Urology and Andrology

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Ureteral stents A) standard ureteral stent. B) endopyelotomy stent

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3. Fig. 2. Schematic representation of the relationship between the internal stent and the ureter wall. A) A standard stent is inserted into the ureter. The arrows indicate how the ureter wall is intimately adjacent to the stent. B) Tandem stenting. The arrows indicate the “useful” space formed between the tandem stents and the ureter wall [29]

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4. Fig. 3. Schematic representation of urine passage during tandem stenting. Arrows indicate: 1 — ureter wall, 2 — internal lumens of stents, 3 — “useful space”. Possible urine passage is indicated in yellow [29]

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5. Fig. 4. General urogram (control) in patient K. Tandem stenting of the right ureter after laser endoureterotomy of a recurrent iatrogenic stricture localized in the lower third of the ureter. The left ureter is drained with a monostent after contact ureterolithotripsy.

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6. Fig. 5. CT of the kidneys, 3D reconstruction View of installed tandem stents in patient A. after laser endoureterotomy and exposure of tandem stents for 2 months, after removal of the stents, a long relapse-free period was achieved

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7. Fig. 6. Cystoscopic picture of 2 curls of tandem stents in patient S. immediately before their removal 3 months after laser endopyelotomy; a long relapse-free period was achieved.

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