Novel dual-lumen ureteral stents provide better ureteral flow than single ureteral stent in ex vivo porcine kidney model of extrinsic ureteral obstruction

Abstract

Objectives: In the instance of extrinsic ureteral obstruction, indwelling ureteral stents have a high failure rate. Although technically challenging, simultaneous insertion of two ipsilateral stents can achieve better flow rates with time. A novel dual-lumen stent, composed of two adhered ureteral stents, offers the additional benefit of easier placement than a single guidewire. Using a novel ex vivo porcine model, the flow rates within an extrinsically obstructed renal unit were evaluated using two internal ipsilateral stents and two prototype double-lumen stents.

Methods: Sixteen renal units were harvested from eight adult Yorkshire female pigs. To quantify flow, the kidneys were infused at a constant pressure, and the corresponding ureteral drainage was measured for a defined interval. The flow was measured with a standard 7F double-pigtail stent, two ipsilateral 7F double-pigtail stents, a 7F novel double-lumen stent designed with both distal lumens open, and a 7F novel double-lumen stent with one distal lumen closed. The intraluminal and extraluminal flow in obstructed and nonobstructed systems was measured.

Results: The two ipsilateral standard stents or prototype double stents achieved better flow down the ureter than did one standard stent (P <0.05). The intraluminal and extraluminal flow in the novel stents was statistically greater than the corresponding flow in the standard double-pigtail stent (P <0.01). The extraluminal and obstructed flow was lowest for the standard double-pigtail stent.

Conclusions: Novel dual-lumen prototype ureteral stents provided better flow than a single stent in extrinsically obstructed ureters with the proposed added benefit of easier retrograde insertion compared with a single guidewire.