1. 1Haifler M1,2, Weiss D3, Winkler H1, Ramon J1, Einav S 3, Kleinmann N
Malignant ureteral obstruction relieved by stiff tandem ureteral stents
1Haifler M1,2, Weiss D3, Winkler H1, Ramon J1, Einav S 3, Kleinmann N
1 Department of Urology, Chaim Sheba medical center
2 OMNI research group, Department of biomedical engineering, Tel Aviv University
3 Cardiovascular System and Bioengineering Laboratory, Department of biomedical engineering
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2. Introduction
Malignant ureteral obstruction (MUO) usually portends poor prognosis
Many of these cases are refractory to standard ureteral stent drainage
The gold standard draining method : PCN
PCN drainage is accompanied by a significant impairment in quality of life1 1 Scand J Urol Dec 1:1-7
Intro

3. Introduction
Tandem ureteral stents (TUS) may enhance flow through the obstructed ureter by:
Providing additional scaffold
Allowing for extra-luminal flow through the space between the stents1
Using a stiff stent provides adequate drainage and lower renal pelvis pressure2
1 Urology 2002;59:594–596.
2 J Urol Aug;148(2 Pt 1):
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4. Introduction
Artificial and computational models imply on TUS drainage superiority.
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5. Aim
To examine the effect of stiff TUS drainage of MUO on clinical parameters
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6. Material and methods The use of stiff TUS drainage began in June 2014
Surgical technique:
Retrograde pyelogram
A 4cm/18F ureteral balloon dilation catheter (20 atmospheres)
14F ureteral dilator
Two double pigtail stiff ureteral stents were placed under fluoroscopy
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Material and methods

7. Material and methods Data collected: Gender Age Type of primary tumor
Side
Obstruction site
Obstruction length
Failure (need for PCN)
Indication for drainage
Creatinine prior/post drainage
Hydronephrosis prior/post drainage
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8. Material and methods
14 patients / 22 renal units (ru) were drained between 6/2014 – 4/2015 Median age – 55y (IQR 35-65) M/F – 6/8 patients
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9. Results Indication for drainage: Renal failure – 14 ru
PCN discomfort – 3 ru
Sepsis – 2 ru
Flank pain – 2 ru
Type of primary tumor :
Gastrointestinal – 5 pt
Genitourinary – 3 pt
Gynecological – 5 pt
Lymphoma – 1 pt
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10. Results 2 month post tandem TUS drainage
1 month prior to tandem TUS drainage
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11. Results Improvement in renal failure occurred in 86% of patients
Follow-up period – 24 w (IQR 11-30)
Failure – 8 (38.1%)
All failures occurred due to urosepsis
Median time to failure – 16 w
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12. Conclusions Most patients benefit from TUS drainage
Failure occurs after several weeks in the minority of patients
Further prospective trials should delineate the role of this type of drainage technique in this clinical scenario
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13. THANK YOU!
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