15-Year Experience With the Management of Extrinsic Ureteral Obstruction With Indwelling Ureteral Stents

Chung, Steve Y.; Stein, Robert J.; Landsittel, Douglas; Davies, Ben; Cuellar, David C.; Hrebinko, Ronald L.; Tarin, Tatum; Averch, Timothy D.

doi:10.1097/01.ju.0000130510.28768.f5

Cited by 204 publications

(157 citation statements)

References 17 publications

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“…[7][8][9] A failure rate of 43% (20 of 46 stents) for extrinsic ureteral obstruction was first reported by Docimo and Dewolf. 7 Similar failure rates of 42% (58 of 138) 1 and 36% (56 of 157) 9 were reported in 2 larger retrospective series. In a prospective study of stent placement in 92 patients with intrinsic obstruction or malignant external obstruction, the MUO subset had significantly higher rates of failure (44% vs 27%, p ϭ 0.001).…”

Section: Discussionsupporting

confidence: 81%

“…Because of the novel stent material and design, we hypothesized that risk factors for failure identified for traditional stents, including the presence of malignant bladder invasion, 9 distal level of obstruction 8 and increased serum creatinine, 1,8 would not impact the outcome of this metallic device. Notably Cox regression analysis revealed that patients with prostate cancer invading the bladder at cystoscopy had a significantly increased risk of failure (HR 6.50, 95% CI 1.45-29.20, p ϭ 0.015).…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3] The prognosis for these patients is universally poor, with multiple studies reporting overall survival of less than 1 year after intervention for MUO. 4 -6 Ureteral stenting may be indicated to minimize pain or to maximize renal function, especially if further chemotherapy is planned.…”

mentioning

confidence: 99%

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Outcomes of Metallic Stents for Malignant Ureteral Obstruction

et al. 2012

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Purpose: Malignant ureteral obstruction often necessitates chronic urinary diversion and is associated with high rates of failure with traditional ureteral stents. We evaluated the outcomes of a metallic stent placed for malignant ureteral obstruction and determined the impact of risk factors previously associated with increased failure rates of traditional stents. Materials and Methods: Patients undergoing placement of the metallic Resonance® stent for malignant ureteral obstruction at an academic referral center were identified retrospectively. Stent failure was defined as unplanned stent exchange or nephrostomy tube placement for signs or symptoms of recurrent ureteral obstruction (recurrent hydroureteronephrosis or increasing creatinine). Predictors of time to stent failure were assessed using Cox regression. Results: A total of 37 stents were placed in 25 patients with malignant ureteral obstruction. Of these stents 12 (35%) were identified to fail. Progressive hydroureteronephrosis and increasing creatinine were the most common signs of stent failure. Three failed stents had migrated distally and no stents required removal for recurrent infection. Patients with evidence of prostate cancer invading the bladder at stent placement were found to have a significantly increased risk of failure (HR 6.50, 95% CI 1.45-29.20, p ϭ 0.015). Notably symptomatic subcapsular hematomas were identified in 3 patients after metallic stent placement. Conclusions: Failure rates with a metallic stent are similar to those historically observed with traditional polyurethane based stents in malignant ureteral obstruction. The invasion of prostate cancer in the bladder significantly increases the risk of failure. Patients should be counseled and observed for subcapsular hematoma formation with this device.

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Section: Discussionsupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

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Outcomes of Metallic Stents for Malignant Ureteral Obstruction

et al. 2012

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“…1,4,5 The severity of hydronephrosis was graded by ultrasonography according to the grading system of the Society for Fetal Urology (SFU). 6 Performance status (PS) was evaluated according to the Eastern Cooperative Oncology Group (ECOG) PS.…”

Section: Methodsmentioning

confidence: 99%

“…The median survival of patients with MEUO ranges from 3 to 7 months. [1][2][3][4] In such patients with MEUO, retrograde ureteral stenting is usually considered as an initial treatment. However, adequate stent placement across an obstructed ureteral segment does not necessarily guarantee adequate urine drainage.…”

Section: Introductionmentioning

confidence: 99%

Stent failure in the management of malignant extrinsic ureteral obstruction: Risk factors

et al. 2011

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There is still controversy surrounding the indications for performing either a retrograde ureteral stent or percutaneous nephrostomy to manage malignant extrinsic ureteral obstruction (MEUO). We retrospectively analyzed 53 patients who underwent a decompression of MEUO using retrograde ureteral stent. Ureteral stent failure occurred in 18 of 53 patients (34%). Multivariate analysis showed that gastrointestinal cancer as the primary disease, poor preoperative performance status and severe preoperative hydronephrosis were independent predictors of stent failure. Based on the present data, we propose an algorithm for the management of MEUO.

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Physical Characteristics of Stents

Gridley

Knudsen

2017

Ureteric Stenting

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15-Year Experience With the Management of Extrinsic Ureteral Obstruction With Indwelling Ureteral Stents

Cited by 204 publications

References 17 publications

Outcomes of Metallic Stents for Malignant Ureteral Obstruction

Outcomes of Metallic Stents for Malignant Ureteral Obstruction

Stent failure in the management of malignant extrinsic ureteral obstruction: Risk factors

Physical Characteristics of Stents

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