The ureteral stent is engrained in the fabric of urologic practice. Virginia Mason Medical Center had a unique role in its development through the pioneering work of Dr. Robert Gibbons. Here, we review his contribution to the evolution of the modern ureteral stent.
We reviewed Dr. Gibbons' extensive work through primary sources, including interviews, projector slides, radiology images, stent prototypes, his personal writings and archived documents. In addition, we performed a review of historical texts and manuscripts describing important innovations in the development of the ureteral stent.
In 1972, motivated by a desire to provide his patients with a long-term alternative to open nephrostomy and inspired by Drs. David Davis and Paul Zimskind, who in 1967 had described the use of indwelling ureteral silicone tubing, Dr. Gibbons began to experiment with modifications to improve upon existing stents. To address distal migration, Dr. Gibbons added "wings" that collapsed as the stent was advanced and expanded once in proper position to secure the stent in place. Barium was embedded into the proximal tip to facilitate radiographic visualization. A flange was added to the distal end, preventing proximal migration and minimizing trigonal irritation, and a tail was attached to aid in stent removal. The result was the original Gibbons stent, the first commercially available ureteral stent, and the establishment of CPT code 52332, still used today.
The ureteral stent is a fundamental component of urologic practice. In developing the Gibbons stent, Dr. Gibbons played a pivotal role in addressing the challenge of internal urinary diversion particularly for those who needed long-term management. Urologists and the patients they serve owe Dr. Gibbons and other surgeon inventors a debt of gratitude for their innovative work.
Urology. 2018 Mar 12 [Epub ahead of print]
Ryan P Donahue, Andrew W Stamm, Robert P Gibbons, Christopher R Porter, Kathleen C Kobashi, John M Corman, Una J Lee
Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA 98101.