Name:
Placement of Resonance Stent for Malignant or Benign Ureteral Obstruction
Description:
Placement of Resonance Stent for Malignant or Benign Ureteral Obstruction
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/d470e9cd-8add-45f6-a82e-bf3dbd59d98e/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=WWMe1hK94FY5V%2FzGm8mpki6O88zWXNRnN%2BILoBlNwfg%3D&st=2026-06-11T04%3A51%3A08Z&se=2026-06-11T08%3A56%3A08Z&sp=r
Duration:
T00H06M05S
Embed URL:
https://stream.cadmore.media/player/d470e9cd-8add-45f6-a82e-bf3dbd59d98e
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/d470e9cd-8add-45f6-a82e-bf3dbd59d98e/Placement of Resonance Stent for Malignant or Benign Uretera.mp4?sv=2019-02-02&sr=c&sig=HWEYD2gubuJkja%2F9x%2BzechgFwnBSzWlUQDRs0aLyxcE%3D&st=2026-06-11T04%3A51%3A09Z&se=2026-06-11T06%3A56%3A09Z&sp=r
Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 INTRODUCTION.
SPEAKER: In this video, we demonstrate a step by step guide for placement of a resonance or metal ureteral stent. The patient presented in the video, it's an 81-year-old male with metastatic prostate cancer initially diagnosed in 2010. He has been managed with androgen deprivation treatment. On his imaging, he was found to have bilateral ureteral obstruction suspected to be from extrinsic compression from retroperitoneal lymphadenopathy.
SPEAKER: In 2019, when the diagnosis was made, he elected to be managed with chronic indwelling ureteral
SPEAKER: stents.
Segment:2 PATIENT POSITIONING.
SPEAKER: Patient is positioned in a dorsal lithotomy position, making sure all pressure points are padded appropriately to avoid nerve related injury. The C arm and fluoroscopy monitor is placed on one side and the endoscopic monitor on the contralateral side of the patient.
SPEAKER: Alternative monitor replacement can be utilized.
SPEAKER: Cystoscopy is performed using a rigid 21 French cystoscope
Segment:3 CYSTOSCOPY.
SPEAKER: to gain access to the bladder. The urethra and bladder are assessed for any abnormalities. Alternatively, a flexible cystoscope can be utilized for this step. [MUSIC PLAYING]
Segment:4 DEPLOYMENT OF GUIDEWIRE.
SPEAKER: If there is an existing stent in place, the ureteral orifice is cannulated alongside the existing stent with an open ended ureteral catheter.
SPEAKER: Censored guidewire is deployed into the collecting system, and positioning is confirmed with fluoroscopy. [MUSIC PLAYING]
Segment:5 REMOVAL OF EXISTING RESONANCE STENT.
SPEAKER: Once the guidewire is positioned in the collecting system, the existing stent is removed with a flexible stent grasper.
SPEAKER: It is advised to perform this with the aid of fluoroscopy to ensure proper uncurling of the proximal end of the stent, especially if incrustation is suspected. [MUSIC PLAYING]
Segment:6 RETROGRADE PYELOGRAM.
SPEAKER: Retrograde ureteral pyelogram is performed to assess the narrowed segment of the ureter as seen in this image.
SPEAKER: The renal pelvis is opacified, and the guidewire is replaced in the collecting system.
Segment:7 PLACEMENT OF OBTURATOR AND SHEATH.
SPEAKER: Using endoscopic guidance, the clear sheath and obturator,
SPEAKER: which comes with a resonance stent set, is deployed over to guidewire into the collecting system. The radiopaque marker of this sheath is positioned just above the ureteral pelvic junction. [MUSIC PLAYING]
Segment:8 REMOVAL OF OBTURATOR AND WIRE.
SPEAKER: The obturator is then removed and drainage from the clear stent sheath confirms proper positioning within the renal pelvis.
SPEAKER: The resonance, or metal stent, is then placed within the clear sheath and deployed into the collecting system using the obturator. It is our practice to deploy the stent with endoscopic guidance to simultaneously evaluate the positioning of the distal curl. Once the proximal curl is positioned in the collecting system that's confirmed under fluoroscopy, the clear obturator and sheath are removed under direct vision.
SPEAKER: And the distal curl is positioned nicely in the bladder. [MUSIC PLAYING] It can be seen here, as the stent is deployed, the clear catheter is removed simultaneously under direct vision.
SPEAKER: This requires delicate balance of keeping stent in place while removing the clear catheter. Intermittent liberal use of fluoroscopy during this step is advised to prevent unplanned migration of metallic stent. Once the stent is placed, the bladder is then drained at the end of the procedure.
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