Patients who are suffering with malignant ureteric obstruction & poor life expectancy generally requires for placement of ureteral stents to reduce the urinary obstruction & as a palliative measure to relive the pain and avoid major surgeries. Metallic ureteric stents has recently been developed to offer and try better relief of obstruction compared to polymeric (polyurethane) stents because of: enhanced maintaining of ureteral patency in the malignancy when conventional polyurethane stents were generally occluded, increased intervals between changes, bleeding as in nephrostomy tubes, less liable to the infections, less irritation of lower urinary tract compared to JJ catheter.
Memokanth stent placement was done through an antegrade approach. In this case with transplant ureteral stenosis, doctor will passes a hydrophilic guidewire from ureter across stenotic segment to the bladder, and exchanged this guidewire for amplatz extrastiff guidewire to present more stability.
Previous to the stent placement, 6mm balloon catheters were used to dilate the stenotic segment. Then advanced the stent assembly over the guidewire beneath the fluoroscopic guidance & also used real-time US in order to observe the ureter-bladder junction.
The stent assemblies are flushed with sterile saline warmed at 50C. The stent are detached & its proximal end will form a funnel shape.
The guidewire was kept in a place when the removal of the introducing catheter. The nephrostomy catheter was left inside the collecting system till control antegrade pyelography was performed the day after the procedure, and later it was removed.