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2018 ; 4
(1
): 42-44
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English Wikipedia
Quarter Century Management of Chronic Ureteropelvic Junction Obstruction in a
Solitary Kidney with a Ureteral Stent
#MMPMID29662959
Abedi G
; Patel RM
; Lin C
; Clayman RV
J Endourol Case Rep
2018[]; 4
(1
): 42-44
PMID29662959
show ga
Background: The ureteral stent provides a conduit for urinary drainage from the
kidney to the bladder and is integral to contemporary urologic practice. A
ureteral stent is often utilized in acute conditions to prevent or overcome
obstruction; however, in nonsurgical patients, because of disease or preference,
a ureteral stent may be used as a last resort for long-term management of a
stricture in lieu of a nephrostomy tube. This case highlights a patient whose
chronic ureteral obstruction has been managed with an indwelling ureteral stent
for 25 years; remarkably, stent exchanges are currently required only every 2
years. Case Presentation: A 33-year-old man initially presented with a solitary
left kidney and a ureteropelvic junction obstruction. The patient's right kidney
was nonfunctioning since childhood because of a presumed ureteropelvic junction
obstruction with grade IV hydronephrosis. The patient underwent two failed open
repairs of the left kidney in the 1980s, resulting in a totally intrarenal,
constricted renal pelvis; an endopyelotomy in 1992 also failed and required
angioembolizaton of a segmental renal vessel. The patient refused any further
surgical procedures and thus has been managed exclusively with a 7/14F?×?28?cm
endopyelotomy stent (Boston Scientific(®)) for 25 years; the interval between
stent changes was slowly expanded until they are now being done at 2-year
intervals. The patient has not developed recurrent urinary tract infections,
stent colic, or stent encrustation. Conclusion: Patients who require chronic
indwelling ureteral stents are rare. In this situation, with careful monitoring,
the interval between stent exchanges was extended to 2 years, thereby precluding
a chronic nephrostomy tube.