Head-tail stress-free metal stent for complex ureteral stricture: 3 years of experience with 417 cases

Background: The application of metal ureteral stents emerges as a promising therapeutic alternative for complex ureteral strictures. Nevertheless, the conventional segmented stent design predisposes to complications such as migration and urothelial hyperplasia, leading to treatment failure. This study introduced an innovative head-tail stress-free (HTSF) technique and to compare the long-term effectiveness and safety between HTSF and traditional segmented placement. Materials and methods: This retrospective cohort analysis evaluated 417 patients undergoing ureteral stent placement (HTSF technique: n = 258; traditional method: n = 159) with a minimum follow-up of 24 months. In the traditional group, metal stents were positioned with ≥ 2 cm extension beyond stricture margins at both ends. In the HTSF group, two or more metal stents were placed to ensure that head-tail ends of stents resided within a large lumen. Results: The median follow-up times were 32.0 and 27.0 months in the traditional and HTSF groups, respectively. HTSF placement achieved a significant higher success rate (89.5% vs. 45.9%, P<0.001), a lower rate of stent migration (5.4% vs. 44.0%, P<0.001), and occlusion (1.9% vs. 6.3%, P = 0.020). Under ureteroscopy, the HTSF group exhibited a lower rate of urothelial hyperplasia (1.9% vs. 29.6%, P<0.001). Furthermore, the HTSF group had a slightly lower score of Ureteral Stent Symptoms Questionnaire (USSQ) (P = 0.040) and greater relief in hydronephrosis volume (P = 0.013). Conclusion: The HTSF technique significantly improved success rates while reducing the incidence of stent migration, occlusion, and urothelial hyperplasia. Moreover, HTSF did not exacerbate stent-related symptoms and contributed to improved long-term satisfaction.