Antegrade Ureteric Stenting in Management of Ureteric Obstruction in Case of Difficult Retrograde Access; Indications, Success Rates & Predictors of Failure

Abstract

ur results of success as regard of antegrade double j stenting are promising, with acceptable range of complications, if to criticize our study is the 1- Wide range of pathologies which could be justified by the paucity of studies about the antegrade double j stenting although its well-known procedure, so those bunch of pathologies can open away for separate studies of each pathology. 2- Also randomization between antegrade & retrograde stenting is not justified with superiority & feasibility of the conventional retrograde cystoscopic insertion. 3- In face of some patients vulnerability & complicated situations (patients with uretero-enteric anastomotic strictures after urinary diversion & patients with iatrogenic injury) we preferred to go directly for antegrade stenting especially in those with solitary kidney or border line serum creatinine or in patients can't tolerate the longer anesthesia time or can't be positioned in lithotomy. Based on our primary experience and our honest opinion, antegrade double j insertion using the Galadako Modified Valdivia was not only successful alternative way in case of failed retrograde access but also it gives higher success rate where difficulties of retrograde stenting may be suspected, with superiority as regard time consumed, regional or spinal anesthesia. Antegrade double j stenting is appealing in some situations e.g. malignant ureteric obstruction caused by pelvic malignancies & 2ry strictures at the uretro-enteric anastomosis following urinary diversion.