Allium ureteral stent (URS) are be widely applied for patients with ureteral stricture, researches unremittingly reported its clinical safety and efficacy. Here we report our technique and the outcomes of the treatment with Allium URS on the refractory ureteral stricture, including results, complications, adverse effects and application in special cases.

We retrospectively collected perioperative variables on all patients who were treated with an Allium URS in our department between January 2017 and April 2024, and the outcomes were assessed.

The study cohort included 23 patients and 25 cases, with a mean age of 57.70 years (range 32-76 years). Primary stricture site included 11, 10 and 2 cases of left, right and bilateral ureters, respectively. The mean length of ureteral stricture was 4.5 cm (range 1-18 cm). The etiology of ureteral stenosis includes failed UPJO pyeloplasty (4.35%), lithotripsy (8.70%), iatrogenic injury/synechia by abdominal/pelvic surgery (26.09%), tumor invasion (30.43%), radiotherapy (17.39%) and others (13.04%). All stents were inserted successfully and positioned correctly in the 25 ureters. About 48% were inserted Allium URS with balloon dilatation, 12% with ureteral sheath, and 40% were just with rigidscope dilatation. To 2024 December, the long-tern stent patency rate is 68% with a median follow-up time of 39.5 months (range 13-67 months). For the 8 cases of stent patency failure, the mean indwelling time of the Allium stent was 14 months, with the shortest recorded time being 2 months. Failure reasons included occurred stent migration (50%), stent encrustation (12.5%), still stenosis (25%) and severe infection (12.5%). Interventions for these patients covered just Allium URS removal (25%), robot-assisted pyeloureteroplasty (25%), ureteralithotripsy (12.5%), switch (12.5%) or add new Allium URS (12.5%), and switch new another kind of metal stent (12.5%). Specially, one case of the ruptured ureter was bridged with Allium URS, and another case of uretero-vaginal fistula was repaired by Allium URS successfully with no complications.

Although Allium URS could be considered as a feasible and attractive treatment for various ureteral strictures even ureteral perforation and rupture, the occurence of long-tern migration and occluded can not be ignored.