A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab

Abstract

BackgroundThe angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors.Case presentationWe describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan.ConclusionsSince Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.

Ureteral stent migration through colovesical and vesicovaginal fistulas in a patient with stage IV cervical cancer treated with pelvic radiation

“…A similar case in which a patient treated with surgery, chemotherapy, and radiation for squamous cell carcinoma of the cervix eight years prior to presentation had a displaced ureteral stent into the rectal lumen was reported in BioMed Central Urology [5]. The ureteral stent was placed for cervical cancer recurrence involving the right ureter with hydronephrosis [5]. She was treated with a combination chemotherapy regimen that included a vascular endothelial growth factor (VEGF) inhibitor to prevent angiogenesis of the tumor along with standard treatment with cytotoxic agents (cisplatin, paclitaxel) [5].…”

“…A similar case in which a patient treated with surgery, chemotherapy, and radiation for squamous cell carcinoma of the cervix eight years prior to presentation had a displaced ureteral stent into the rectal lumen was reported in BioMed Central Urology [5]. The ureteral stent was placed for cervical cancer recurrence involving the right ureter with hydronephrosis [5].…”

Laparoscopic Management of a Misplaced Ureteral Stent in the Duodenum

“…2,3 There are few reports of DJS migrating into the rectum after treatment of cervical cancer. 4 There is a single reported case of a 10-year-old patient for forgotten right-sided DJS displacement into the third part of duodenum, which was managed by open right nephrectomy and duodenal repair. 2 Iatrogenic retroperitoneal duodenal rents, although rare, typically occur after gastrointestinal endoluminal interventions such as endoscopic retrograde cholangiopancreatography, biliary endoprosthesis, migrated esophageal and gastroduodenal stents, and endoscopic ultrasonography.…”

“…Extraurinary tract displacements observed in the literature are vascular displacement into inferior vena cava, rarely into right ventricle, into rectum after anticancer treatment of the cervix, and a forgotten stent into third part of the duodenum. [2][3][4] In this study we present a unique case of a displaced DJS into the second part of the duodenum and its successful management laparoscopically.…”

Pharmacological Treatment of Patients with Metastatic, Recurrent or Persistent Cervical Cancer Not Amenable by Surgery or Radiotherapy: State of Art and Perspectives of Clinical Research

“…Response rates and fistula rates with CBDCA + PTX + BEV are similar to those reported with CDDP + PTX + BEV [ 114 , 115 ]. The risks and benefits of the addition of BEV to chemotherapy should be exhaustively discussed with the patient herself, taking into account the increased probability of fistula formation, especially in the case of locally persistent or recurrent disease after radiotherapy or CCRT [ 116 , 117 , 118 ]. Hypoalbuminemia is an additional risk factor for fistula formation [ 119 ].…”