Nearly all pelvic and retroperitoneal tumours give rise to ureteral obstruction, due to various reasons. This obstruction can be due to direct pressure effect of the tumour or secondary to the treatment related periureteral fibrosis or injury. Renal failure is a grave consequence if both the ureters are blocked. Conventionally per-cutaneous nephrostomy (PCN) and ureteral DJ-stents have been used to deobstruct the kidneys. Open ureteral surgeries are very difficult and have high failure rates, especially post Chemotherapy and Radiation Therapy. Both endoscopic and open procedures have their own share of shortcomings and advantages. Conventionally an indwelling ureteric stent has been the procedure of choice from the patients’ and the surgeons’ perspective. However, these stents have their own shortcomings in the form of severe bladder irritative symptoms, flank pain, encrustation, stone formation and UTI. Hence, these need to be changed at periodic intervals and often have to be taken out altogether. PCNs, on the other hand are better as far as draining they kidneys are concerned. However, they have their own flip side. PCNs are cumbersome to maintain and are often source of infection. They can get clogged and also need to be changed at regular intervals. Besides they get damaged easily and are source of urinary leakages and give rise to nephrocutaneous fistulas when misplaced. Hence, they too have their shape of morbidity. PCNs also restrict a person’s social mobility. Looking t these aspects of morbidities, cost and recurrent surgeries, a permanent indwelling ureteral stent, without the handicaps of conventional DJ stent, is a good option. An innovative self expanding biocompatible stent offers a new ray of hope for this class of patients. This stent : Memokth (Pnn Medicals-Denmark) is made of nitinol alloy and has been shown to remain in situ (now 7 years follow up are available) without the said complications. It is nearly asymptomatic when placed in ureter and has not shown any tissue growth or encrustations at check ureterscopy. Although, some degree of expertise is needed for its placement, it is good option to salvage renal function. We, at Dharamshila Hospital and Research Centre are proud to announce the first Memokath placement in Indi. The said patient had carcinoma cervix four years back, which was successfully treated by a combination of surgery, chemotherapy and Radiation therapy. However, she had urosepsis and renal insufficiency due to obstructive uropathy. She had to be taken up for repeated stenting or PCN to salvage her right kidney, which had multiple ureteral fibrotic obstructions. She had no locoregional or distant cancer residuals or relapse. After discussions in tumour board, Memokath (20 cm size) was placed in her right ureter in October 2012. She didn’t have any peri-operative complications. At present, she is in healthy and stable condition and she is off medications for the first time in last four years. This stent is costing about 1.7 lakhs. However, its long term durability and obviating the need for repeated PCN’s / DJ stenting or an open procedure, makes it much more patient friendly and cost-effective. The morbidity associated with various repetitive procedures are also obviated. After a period of one year, this permanent stent is more cost effective then the conventional procedures and we recommend its use in selected cases.
Permanent Ureteral Stents – A New Lease of Life!