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Ureteroarterial fistula following retrograde ureteral stenting in a patient with a double-barreled wet colostomy for cervical cancer.

ABSTRACT: •Ureteroarterial fistula (UAF) is a rare cause of massive hematuria.•Percutaneous retrograde ureteral stents via DBWC can be done safely in the compliant patient for improved comfort.•Understanding the anatomy, risks, and minimally invasive treatment options for UAF is important for prompt patient care.

SUBMITTER: Siorek M

PROVIDER: S-EPMC4563588 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Ureteroarterial fistula following retrograde ureteral stenting in a patient with a double-barreled wet colostomy for cervical cancer.

Siorek Marek M Tierney Brent B Fowler Jeffrey J Dowell Joshua D JD

Gynecologic oncology reports 20150623

•Ureteroarterial fistula (UAF) is a rare cause of massive hematuria.•Percutaneous retrograde ureteral stents via DBWC can be done safely in the compliant patient for improved comfort.•Understanding the anatomy, risks, and minimally invasive treatment options for UAF is important for prompt patient care. ...[more]

PMID: 26425720

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Retrograde pyelography predicts retrograde ureteral stenting failure and reduces unnecessary stenting trials in patients with advanced non-urological malignant ureteral obstruction.

Project description:ObjectiveTo evaluate predictive factors for retrograde ureteral stent failure in patients with non-urological malignant ureteral obstruction.Materials and methodsBetween 2005 and 2014, medical records of 284 malignant ureteral obstruction patients with 712 retrograde ureteral stent trials including 63 (22.2%) having bilateral malignant ureteral obstruction were retrospectively reviewed. Retrograde ureteral stent failure was defined as the inability to place ureteral stents by cystoscopy, recurrent stent obstruction within one month, or non-relief of azotemia within one week from the prior retrograde ureteral stent. The clinicopathological parameters and first retrograde pyelographic findings were analyzed to investigate the predictive factors for retrograde ureteral stent failure and conversion to percutaneous nephrostomy in multivariate analysis with a statistical significance of p < 0.05.ResultsRetrograde ureteral stent failure was detected in 14.1% of patients. The mean number of retrograde ureteral stent placements and indwelling duration of the ureteral stents were 2.5 ± 2.6 times and 8.6 ± 4.0 months, respectively. Multivariate analyses identified several specific RGP findings as significant predictive factors for retrograde ureteral stent failure (p < 0.05). The significant retrograde pyelographic findings included grade 4 hydronephrosis (hazard ratio 4.10, 95% confidence interval 1.39-12.09), irreversible ureteral kinking (hazard ratio 2.72, confidence interval 1.03-7.18), presence of bladder invasion (hazard ratio 4.78, confidence interval 1.81-12.63), and multiple lesions of ureteral stricture (hazard ratio 3.46, confidence interval 1.35-8.83) (p < 0.05).ConclusionRetrograde pyelography might prevent unnecessary and ineffective retrograde ureteral stent trials in patients with advanced non-urological malignant ureteral obstruction.

| S-EPMC5607161 | biostudies-literature

Antegrade Ureteral Stenting is a Good Alternative for the Retrograde Approach.

Project description:Double J (JJ) stents for treating obstructive ureteral pathology are generally inserted through a retrograde route with cystoscopic guidance. Antegrade percutaneous insertion using fluoroscopy can be performed alternatively but is less known. Indications, success rate and complications of antegrade ureteral stenting were evaluated.Data of consecutive patients in which antegrade ureteral stenting was performed were retrospectively analysed using the radiology information system and patient records. Patient characteristics, details of the antegrade JJ stent insertion procedure and registered complications were collected. Furthermore, it was investigated if prior to the antegrade procedure a retrograde attempt for JJ stent insertion was performed.Total 130 attempts for antegrade JJ stent insertion were performed in 100 patients. A percutaneous nephrostomy catheter had already been placed in the majority of kidneys (n = 109) for initial treatment of hydronephrosis. Most prevelant indication for a JJ stent was obstructive ureteral pathology due to malignancy (n = 63). A JJ stent was successfully inserted in 125 of 130 procedures. In 21 cases, previous retrograde ureteral stenting had failed but, subsequent antegrade ureteral stenting was successful. There were 8 procedure related complications; 6 infections, 1 false tract and 1 malposition.Antegrade percutaneous insertion of a JJ stent is a good alternative for retrograde insertion.

| S-EPMC5527183 | biostudies-other

Technical considerations of coarctation stenting in double-barreled aorta - A persistent fifth arch mimic.

Project description:The double-barreled aorta connecting the ascending aorta and descending aorta caudal to the normal fourth aortic arch has fascinated the interests of cardiac morphologists for over a century. This condition is commonly associated with coarctation. While the controversies surrounding the embryology of the double-barreled aorta have settled down, we present a case-based illustration of the technical aspects of coarctation stenting peculiar to this condition.

| S-EPMC8174644 | biostudies-literature

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones.

Project description:Background and aimUreteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones.MethodsDatabases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software.ResultsWe identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group.ConclusionsOur analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.

| S-EPMC5221881 | biostudies-literature

Gated Single-Molecule Transport in Double-Barreled Nanopores.

Project description:Single-molecule methods have been rapidly developing with the appealing prospect of transforming conventional ensemble-averaged analytical techniques. However, challenges remain especially in improving detection sensitivity and controlling molecular transport. In this article, we present a direct method for the fabrication of analytical sensors that combine the advantages of nanopores and field-effect transistors for simultaneous label-free single-molecule detection and manipulation. We show that these hybrid sensors have perfectly aligned nanopores and field-effect transistor components making it possible to detect molecular events with up to near 100% synchronization. Furthermore, we show that the transport across the nanopore can be voltage-gated to switch on/off translocations in real time. Finally, surface functionalization of the gate electrode can also be used to fine tune transport properties enabling more active control over the translocation velocity and capture rates.

| S-EPMC6243394 | biostudies-literature

Magnetic versus conventional stent in ureteral stenting: meta-analysis.

Project description: Not available

| S-EPMC11287378 | biostudies-literature

Double-barreled gun: Combination of PARP inhibitor with conventional chemotherapy.

Project description:DNA repair pathways are evolutionarily conserved molecular mechanisms that maintain the integrity of genomic DNA. In cancer therapies, the integrity and activity of DNA repair pathways predict therapy resistance and disease outcome. Members of the poly (ADP-ribose) polymerase (PARP) family initiate and organize the biologic process of DNA repair, which counteracts many types of chemotherapies. Since the first development in approximately 3 decades ago, PARP inhibitors have greatly changed the concept of cancer therapy, leading to encouraging improvements in tumor suppression and disease outcomes. Here we summaries both pre-clinical and clinical findings of PARP inhibitors applications, particularly for combination therapies.

| S-EPMC6067963 | biostudies-literature

Arterio-ureteral fistula: a nationwide cross-sectional questionnaire analysis.

Project description:PurposeArterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists' experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice.MethodsA nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used.ResultsResponse rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention.ConclusionThe diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.

| S-EPMC8783176 | biostudies-literature

Mechanistic signs of double-barreled structure in a fluoride ion channel.

Project description:The Fluc family of F(-) ion channels protects prokaryotes and lower eukaryotes from the toxicity of environmental F(-). In bacteria, these channels are built as dual-topology dimers whereby the two subunits assemble in antiparallel transmembrane orientation. Recent crystal structures suggested that Fluc channels contain two separate ion-conduction pathways, each with two F(-) binding sites, but no functional correlates of this unusual architecture have been reported. Experiments here fill this gap by examining the consequences of mutating two conserved F(-)-coordinating phenylalanine residues. Substitution of each phenylalanine specifically extinguishes its associated F(-) binding site in crystal structures and concomitantly inhibits F(-) permeation. Functional analysis of concatemeric channels, which permit mutagenic manipulation of individual pores, show that each pore can be separately inactivated without blocking F(-) conduction through its symmetry-related twin. The results strongly support dual-pathway architecture of Fluc channels.

| S-EPMC4969038 | biostudies-literature

Analysis of the factors influencing retrograde removal of double J ureteral stents using a simple snare technique in female patients.

Project description:BackgroundTo identify the factors related to the effectiveness of retrograde removal of double J ureteral stents using a simple snare technique in female patients.MethodsIt was a retrospective observational study. From 2012 to 2017, 128 female patients underwent fluoroscopy-guided, retrograde double J stent removal with or without replacement using a simple snare technique. The position of the tip of the double J stent in the urinary bladder was classified according to position types A, B, C, and D, corresponding to the ipsilateral lateral, ipsilateral medial, contralateral medial, and contralateral lateral quadrants of the urinary bladder, respectively. The factors influencing the fluoroscopy time upon removal of the double J stent were analyzed.ResultsTechnical success rate of 312 procedures performed was 97.44% (304/312) with the mean fluoroscopy time of 12.68±7.34 minutes. Eight double J stent removal procedures failed, and all of these occurred in the position type D patients. The position type and the number of curls of the double J stent had a significant influence on the fluoroscopy time (P<0.05). In addition, multiple regression analysis demonstrated that the position type and number of curls in the double J stent were factors independently influenced the fluoroscopy time (P=0.001). Type D exhibited the longest fluoroscopy time followed by types B and C, and type A had the shortest fluoroscopy time. There were only minor complications consisting of urethral orifice pain (5.1%, 16/312) or gross hematuria (3.2%, 10/312), all resolved conservatively within 24 hours.ConclusionsThe position type and the number of curls in a double J stent have a significant influence on the effectiveness of retrograde removal of double J stents using a simple snare technique in female patients.

| S-EPMC8106078 | biostudies-literature

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