{"id":1688,"date":"2014-05-13T13:32:46","date_gmt":"2014-05-13T18:32:46","guid":{"rendered":"http:\/\/www.medradclinics.com\/?p=1688"},"modified":"2016-04-01T15:17:49","modified_gmt":"2016-04-01T20:17:49","slug":"internal-stenting-of-the-left-ureter-ken-u-ekechukwu-md-mph-facp","status":"publish","type":"post","link":"https:\/\/www.medradclinics.com\/?p=1688","title":{"rendered":"Internal stenting of the left ureter <i> Ken U. Ekechukwu, MD, MPH, FACP.<\/i>"},"content":{"rendered":"\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-1 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 33%;\n\t\t\t}\n\t\t\t#gallery-1 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-1' class='gallery galleryid-1688 gallery-columns-3 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1692'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_axial-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1692\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_axial-150x150.png 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_axial-109x109.png 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_axial-100x100.png 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1692'>\n\t\t\t\tAxial CT scan of the abdomen before left ureteral stenting showing dilated left ureter.\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1693'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_coronal-1-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1693\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_coronal-1-150x150.png 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_coronal-1-109x109.png 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_coronal-1-100x100.png 100w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_coronal-1.png 300w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1693'>\n\t\t\t\tCoronal CT abdomen and pelvis showing dilated upper left ureter and a large prostate.\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1694'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_sagittal-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1694\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_sagittal-150x150.png 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_sagittal-109x109.png 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Prestenting-AP-CT_sagittal-100x100.png 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1694'>\n\t\t\t\tSagittal CT abdomen and pelvis showing dilated left ureter and calyces\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n\n\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-2 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-2 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-2' class='gallery galleryid-1688 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1690'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Lateral-left-antegrade-pyelogram-during-stenting-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-1690\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Lateral-left-antegrade-pyelogram-during-stenting-150x150.jpg 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Lateral-left-antegrade-pyelogram-during-stenting-109x109.jpg 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Lateral-left-antegrade-pyelogram-during-stenting-100x100.jpg 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-1690'>\n\t\t\t\tLateral fluoroscope early in left ureteral stenting showing dilated left ureter and renal pelvis.\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1691'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Post-ureteral-stenting-and-nephrostomy-catheter-insertion-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-1691\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Post-ureteral-stenting-and-nephrostomy-catheter-insertion-150x150.jpg 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Post-ureteral-stenting-and-nephrostomy-catheter-insertion-109x109.jpg 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Post-ureteral-stenting-and-nephrostomy-catheter-insertion-100x100.jpg 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-1691'>\n\t\t\t\tFrontal fluoroscope after left ureteral stenting and rescue left nephrostomy catheter.\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n\n\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-3 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-3 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-3 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-3 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-3' class='gallery galleryid-1688 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1695'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Sagittal-CAP-post-left-ureteral-stenting-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-3-1695\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Sagittal-CAP-post-left-ureteral-stenting-150x150.png 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Sagittal-CAP-post-left-ureteral-stenting-109x109.png 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Sagittal-CAP-post-left-ureteral-stenting-100x100.png 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-3-1695'>\n\t\t\t\tSagittal CT abdomen and pelvis after left ureteral insertion showing a decompressed collecting system\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1689'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Coronal-CTAP-post-stenting-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-3-1689\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Coronal-CTAP-post-stenting-150x150.png 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Coronal-CTAP-post-stenting-109x109.png 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Coronal-CTAP-post-stenting-100x100.png 100w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Coronal-CTAP-post-stenting.png 300w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-3-1689'>\n\t\t\t\tCoronal CT abdomen and pelvis showing the distal end of the left ureteral stent in the urinary bladder.\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n\n<p style=\"padding-left: 30px;\"><em><span style=\"font-size: 22px;\">These images illustrate the benefit of ureteral stenting. They are of a male patient with benign prostatic hypertrophy, who recently underwent surgical resection of a colonic malignancy. His imaging workup uncovered left hydronephrosis caused by a retroperitonal mass encasing his distal left ureter. It was not possible stent the ureter from a urethral approach, so he was referred to the interventional radiology service.<\/span><\/em><\/p>\n<p style=\"padding-left: 30px;\"><em><span><span style=\"font-size: 22px;\">Using ultrasound, a needle was inserted into a dilated\u00a0<\/span><span style=\"font-size: 22.2222232818604px; line-height: 41.9047660827637px;\">mid-pole<\/span><span style=\"font-size: 22px;\">\u00a0calyx, and an antegrade pyelogram obtained\u00a0through a sheath inserted to secure the access confirmed marked dilation of the left ureter and the collecting structures of the left kidney. Ureteral stent was deployed over a guidewire passed across the distal ureteral stricture into the urinary bladder and its proximal and distal pigtail loops reformed in the bladder and the left renal pelvis, respectively. A capped rescue nephrostomy catheter was left in the renal pelvis, but was removed later, when the ureteral stent proved sufficient in\u00a0<\/span><span style=\"font-size: 22.2222232818604px; line-height: 41.9047660827637px;\">decompressing<\/span><span style=\"font-size: 22px;\">\u00a0the left urinary collecting system.<\/span><\/span><\/em><\/p>\n<p><span style=\"font-size: 22px;\">As I discussed elsewhere, it is important that an obstructed renal collecting system be relieved or the urine accumulated above it and under pressure be drained as soon as possible to avoid renal damage and infection. Optimal relief of such obstruction is with an internal ureteral stent placed through the urethra by a urologist. But when this is infeasible, the stent can be placed antegradely from the back and through the kidney. When successful, a rescue nephrostomy catheter may be left in place, capped, until it is certain that the stent is working well &#8211; unless there is no reason to worry about the stent functioning well. The nephrostomy catheter may be removed in 24 hours &#8211; 48 hours, barring any contraindications.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>These images illustrate the benefit of ureteral stenting. They are of a male patient with benign prostatic hypertrophy, who recently underwent surgical resection of a colonic malignancy. His imaging workup uncovered left hydronephrosis caused by a retroperitonal mass encasing his distal left ureter. It was not possible stent the ureter from a urethral approach, so [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35,83],"tags":[],"class_list":["post-1688","post","type-post","status-publish","format-standard","hentry","category-case-gallery","category-genitourinary-interventions","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1688"}],"version-history":[{"count":21,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1688\/revisions"}],"predecessor-version":[{"id":2574,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1688\/revisions\/2574"}],"wp:attachment":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}