Indications of Stenting in GUTB ?
Indication of stenting
It depends on at what stage of disease patient presents and how bad is the involvement of kidney, ureter and bladder.
Looking at posted images :
place a Ureteral stent early enough when obstructive features are noted on US
or other radiological evaluation. Ureteral stenting of sorts was practiced even
in 1960’s. In India, as per my knowledge goes, It was Prof. Roy Chally who
introduced Ureteral stenting. Those days we did not have ureteral stent as is available
now. We used to place Infant feeding tube into the ureter and hope that it will
remain without migrating. In difficult situations where such a tube was
difficult to be negotiated, Roy used to even open the ureter and place the tube.
Such Informations are historical and no one practices them anymore.
all Ureteral narrowing are due to stricture formation. In many instances, the
lesion in the ureter is in its early manifestation where only the mucosa is
involved and the muscle being spared till then. This mucosal involvement and
the accompanying inflammatory oedema will cause blockage to the free flow of
urine down the ureter. A real stricture of Ureter is produced only when the
muscle layers are also involved. This differentiation has therapeutic
implications. When the disease is confined to the mucosa only, the medical
treatment that is instituted can stop further progress of disease and can
result in healing without much fibrosis and thus preventing from forming
stricture. Ramnathan and M Bhandari (1998) found that that DJ stenting is
successful in 41% of cases. Once the muscle layers are involved, the ureter gets
fibrosed and the ensuing stricture cannot be eliminated on medical Therapy.
Stenting is performed only to prevent renal deterioration due to Strictured
Ureter but it will most often restricture once the stent is removed. Hence
close monitoring will have to be made when stent removal is done after a period
We are taught that Urinary TB produces multiple strictures
and mostly in the lower third of Ureter. There was a teaching in the yore that
a single stricture of the ureter and not in the lower third may not be
Tubercular. This I find not correct as I have seen solitary strictures of the
ureter and in some they were not in the lower third.
In the past, we used Streptomycin, INAH and PAH as the
treatment. The duration of treatment was prolonged. Today we have replaced it
with modern AKT and it is given for a shorter period. The present treatment is
more effective no doubt. But it will heal the ureter by more fibrosis and
denser strictures as against Streptomycin.
There are some who use Steroids, hopefully with a view that
it may reduce the stricture formation. The role of steroids
to prevent ureteral strictures in Urinary TB has remained controversial even
These are some of my views and it may not be acceptable to
many in the present generation.
With warm regards,