Comments about the Cook Medical Resonance Stent | Which Medical Device

I\'ve tried this several times for malignant ureteric obstructions and have had mediocre results - several early failures and only one patient I can think of where the stents lasted more than a few months. I haven\'t done a lot - maybe 10 - but so far I\'m not impressed.

Contrary to competing \"armoured\" ureteral stents, this one does what it is supposed to do, if feasible indwelling at all. The indication of malignant obstruction does not allow for much more than 30% success, generally speaking, by stenting the obstructed region. So, either the indication is to facilitate chemotherapy and there is reasonable decrease in bulk of disease, or you are intending on \"fire and forget\". I place the device two to three times annually, both transurethrally or antegrade. I had one severe complication in a benign indication (man with Ormond\'s disease and anticoagulants developed intractable bleeding that resulted in emergent nefrectomy) that I probably left the stent for too long against better judgement, in hindsight.
The art in using this device is knowing when you have been defeated and switching to percutaneous drainage when failing.