| ORIGINAL ARTICLE |
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| Year : 2011 | Volume
: 27
| Issue : 1 | Page : 19-24 |
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Extra-anatomical complications of antegrade double-J insertion
AR Rao1, A Alleemudder2, G Mukerji1, V Mishra1, H Motiwala1, M Charig1, O. M. A. Karim1
1 Department of Urology and Radiology, Wexham Park Hospital, Slough, United Kingdom
2 Department of Urology, Lincoln County Hospital, Lincolnshire, United Kingdom
Correspondence Address:
A R Rao
Huxley Close, Wexham, SL36LW, Berkshire
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-1591.78408
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Introduction: Insertion of a double-J (JJ) stent is a common procedure often carried out in the retrograde route by the urologists and the antegrade route by the radiologists. Reported complications include stent migration, encrustation, and fracture. Extra-anatomic placement of an antegrade JJ stent is a rare but infrequently recognized complication.
Materials and Methods: We performed a retrospective audit of 165 antegrade JJ stent insertions performed over three consecutive years by a single interventional radiologist. All renal units were hydronephrotic at the time of nephrostomy. All procedures were performed under local anaesthetic with antibiotic prophylaxis.
Results: Antegrade stent insertion was carried out simultaneously at the time of nephrostomy in 55 of the 165 cases (33%). The remainder were inserted at a mean of 2 weeks following decompression. In five (3%) patients, who had delayed antegrade stenting following nephrostomy, the procedure was complicated by silent ureteric perforation and an extra-anatomic placement of the stent. These complications had delayed manifestations, which included two retroperitoneal abscesses, a pelvic urinoma, a case each of ureterorectal fistula, and ureterovaginal fistula. Risk factors for ureteric perforation include previous pelvic malignancy, pelvic surgery, pelvic radiation, and a history of ureteric manipulation.
Conclusion: Antegrade ureteric JJ stenting is a procedure not without complications. Extra-anatomic placement of the antegrade stent is a hitherto the infrequently reported complication but needs a high index of suspicion to be diagnosed. Risk factors for ureteric perforation at the time of stent insertion have to be considered to prevent this potential complication. |
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