The Use of Cook Resonance Metallic Ureteral Stent in Cases of Obstructive Uropathy from Persistent Neoureteral Stenosis, Following Kidney Transplantation

Introduction: Following kidney transplantation, persistent cases of obstructive uropathy from neoureteral stenosis, at the reimplantation site, may require management with permanent, long-term Double-J stenting, following failed open surgical and minimally invasive procedures. We report our experience of the use of Cook Resonance® metallic ureteral stent to manage such cases endourologically. Materials and Methods: Medium-term follow-up of two cases requiring long-term ureteral stenting. Medical records, operative details, and radiologic data were reviewed. Primary outcome was relief of obstructive uropathy, and secondary outcomes included clinicoradiologic complications and cost-effectiveness of the metallic stents compared with standard Double-J stents. Results: Case 1 was a 45-year-old lady with obstructive uropathy after kidney transplantation. To date, she has had four metallic stents, and on review of operative details and radiologic data, there was seen to be a 60% reduction in operation length from the first to fourth stent exchange. Radiation dose exposure saw an 80% reduction from 2852 to 556 CGy·cm2. Following 3 years of follow-up, relief of obstructive uropathy has been maintained, with no radiologic or clinical evidence of complications. Case 2 was a 44-year-old lady with obstructive nephropathy requiring long-term stenting after kidney transplantation. Two stent exchanges have been performed to date with a 38% reduction in operation length from 50 minutes to just 31 minutes. Radiation dose exposure saw a 41% reduction. No clinicoradiologic complications or stent-related symptoms have occurred. Discussion: In our experience, use of metallic stents in transplanted kidneys is safe and feasible, with both patients having effective and sustained relief of obstructive uropathy. This stent appears to be well tolerated and is associated with minimal clinicoradiologic complications. Metallic stent replacement is also cost-effective due to the fact that it only requires annual rather than 6-monthly stent changes.