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S. D. Blaschko, L. A. Deane, A. Krebs, F. Khan, J. F. Borin, A. C. Nguyen, E. M. McDougall, and R. V. Clayman. Univ. of California - Irvine, Orange, California, U.S.A. Management of malignant ureteral obstruction with two double pigtail ureteral stents. J. D. Kaufman and O. Shah. New York University Medical Center, New York, NY, U.S.A. Comparative compression and flow study with a new ureteral stent configuration. G. R. Kolb, D. M. Albala, and D. M. Hoenig. Duke University Medical Center, Durham, N.C., U.S.A. and Montefiore Medical Center, New York, NY, U.S.A. UroToday.com - In these three stent abstracts, there are several important points, particularly as they apply to the use of stents in patients with extrinsic renal obstruction (e.g. metastatic disease affecting the retroperitoneum). On a practical basis, Kaufman and Shah note a 63% success rate among 8 renal units in 6 patients, for relieving obstruction in these patients with placement of two double J stents. Mean follow-up was 5.8 months. This approach, originally described by Liu and Hrebinko (J. Urol. 159: 179, 1998), is a valuable method when these patients fail single stent placement. The authors also note that they were able to salvage three cases by first balloon dilating the narrowed segment prior to placing the double stents. The other two abstracts concern stents specifically designed to resist extrinsic compression. Blaschko and colleagues note their experience with a metal closed ended stent (i.e. Resonance stent from Cook Urological Inc, Spencer, IN) reporting that it performed best under circumstances of extraluminal compression. This stent has been used in Europe with apparently good results. Authors from the same institution (Borin, J. F., Melamud, O., and Clayman, R. V.: J. Endourol. 20: 300, 2006) have reported one clinical case in a patient with malignant retroperitoneal fibrosis; after single and double stents failed, the metal stent relieved obstruction without being changed for a 5 month period. However, it was removed at 5 months due to bladder symptoms. In the abstract by Kolb and colleagues, a novel figure of eight stent with two open lumens (i.e. Open-8 stent) was tested in vitro; it showed superior flow and a nearly 8 fold increase in resistance to extraluminal obstruction when compared with traditional double pigtail stents. Clinical experience pends. By Ralph V. Clayman MD UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
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