The value of antegrade stenting for lower ureteric obstruction.

Eleven kidneys in 10 patients (mean age 80 years) presenting over a period of 1 year with obstruction of the lower ureter secondary to malignant obstruction (8 patients), stone disease (1 patient), and bladder wall hypertrophy (1 patient) underwent nephrostomy with subsequent immediate or delayed antegrade stenting. An antegrade placement of the stent was achieved in 10 of the 11 kidneys (90% success). In three cases a combined procedure was performed with cystoscopic assistance. In most cases there was rapid improvement of renal function following stenting. Insertion of ureteric stents in patients admitted to hospital with malignant ureteric obstruction allowed treatment of their renal failure and subsequent discharge without use of permanent external urinary diversion appliances. No significant complications of the procedure were encountered. Medium term follow-up of patients stented for malignant ureteric obstruction suggests that the stents can be left in place without replacement for up to 20 months.