Harjivan Kohli1, Alexander Tapper2, James Relle2. 1. Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA. 2. Beaumont Health, Royal Oak, Michigan, USA.
Abstract
Background: Irreversible electroporation (IRE) is a soft tissue ablation technique using electrical pulses without thermal energy to create pores in the cell membrane, resulting in death from apoptosis rather than necrosis. Advantages include protection of blood vessels, nerves, and surrounding structures. Documented complications include periprocedure nausea/vomiting, infection, and severe pain. Ureteral stents are frequently used in management of hydronephrosis caused by malignant obstruction. We describe what is to our knowledge the first documentation of stent fragmentation secondary to IRE and subsequent management. Case Presentation: This is a 61-year-old male with history of metastatic rectal adenocarcinoma treated initially with chemotherapy and surgery. Follow-up imaging revealed hydronephrosis and enlarged right iliac lymph node. Ureteral stent was placed for management of the hydronephrosis and the patient was referred to undergo IRE for management of metastatic disease. After treatment, the patient had imaging performed that showed fractured right ureteral stent with proximal portion in the ureter and distal portion floating freely in the bladder. This complication was managed with staged endoscopic procedure involving adjacent ureteral stent placement and subsequent ureteroscopy and stent removal using delta grasper. Conclusion: We describe to our knowledge the first incidence as well as subsequent management of ureteral stent fracture from an increasingly common treatment modality for metastatic disease. Given the frequency of malignant ureteral obstruction managed with ureteral stents, knowledge of potential complications pertaining to the urologist is imperative. Copyright 2020, Mary Ann Liebert, Inc., publishers.
Background: Irreversible electroporation (IRE) is a soft tissue ablation technique using electrical pulses without thermal energy to create pores in the cell membrane, resulting in death from apoptosis rather than necrosis. Advantages include protection of blood vessels, nerves, and surrounding structures. Documented complications include periprocedure nausea/vomiting, infection, and severe pain. Ureteral stents are frequently used in management of hydronephrosis caused by malignant obstruction. We describe what is to our knowledge the first documentation of stent fragmentation secondary to IRE and subsequent management. Case Presentation: This is a 61-year-old male with history of metastatic rectal adenocarcinoma treated initially with chemotherapy and surgery. Follow-up imaging revealed hydronephrosis and enlarged right iliac lymph node. Ureteral stent was placed for management of the hydronephrosis and the patient was referred to undergo IRE for management of metastatic disease. After treatment, the patient had imaging performed that showed fractured right ureteral stent with proximal portion in the ureter and distal portion floating freely in the bladder. This complication was managed with staged endoscopic procedure involving adjacent ureteral stent placement and subsequent ureteroscopy and stent removal using delta grasper. Conclusion: We describe to our knowledge the first incidence as well as subsequent management of ureteral stent fracture from an increasingly common treatment modality for metastatic disease. Given the frequency of malignant ureteral obstruction managed with ureteral stents, knowledge of potential complications pertaining to the urologist is imperative. Copyright 2020, Mary Ann Liebert, Inc., publishers.
Authors: Mikhail Silk; David Tahour; Govindarajan Srimathveeravalli; Stephen B Solomon; Raymond H Thornton Journal: Semin Intervent Radiol Date: 2014-06 Impact factor: 1.513