Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

Abstract

PurposeTo determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction.Materials and MethodsWe retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure.ResultsA univariate analysis indicted that hypoalbuminemia (<3.5 g/dL; hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.21 to 4.86; p=0.012), elevated CRP (≥1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS ≥1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival.ConclusionsA mid or lower ureteral obstruction, GPS ≥1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Stenting for malignant ureteral obstruction: Tandem, metal or metal‐mesh stents

“…Worsening flank pain, deteriorating renal function and worsening hydronephrosis despite stent insertion are commonly considered manifestations of stent failure. Though the timing of stent failure is infrequently reported, when it is included almost 50% of single ureteral stents that fail do so within the first week of placement . Subsequent ureteral stent exchanges rarely perform any better, with patency durations frequently shorter than for the original stent placement …”

Retrograde pyelography predicts retrograde ureteral stenting failure and reduces unnecessary stenting trials in patients with advanced non-urological malignant ureteral obstruction

“…Some risk factors for RUS failure were identified, but other factors were not significant predictive factors for RUS failure relating to prognostic survival because adequate MUO management by successful RUS improves survival in patients with advanced or metastatic tumors [ 1 , 3 – 5 , 7 – 14 , 16 , 18 – 20 ]. This study also evaluated the significant predictive factors for RUS failure to identify several specific RGP imaging parameters (p < 0.05, Table 3 ).…”

Outcome of retrograde ureteric stenting as a urinary drainage procedure in ureteric obstruction related to malignant lesions

“…This resulted in a female preponderance in the study sample. The common causes of UORM described in other countries are periureteric metastases due to gastric cancer in Korea and carcinoma of prostate and bladder cancer in the UK and Europe [2,[4][5][6]. These are also the common malignancies in the respective countries [11].…”

“…Departments of Urology 1 Papers periureteric metastases of gastric cancer in Korea [2,4] and carcinoma of prostate and bladder in Europe [5,6]. However, in Sri Lanka such malignancies are less common [7].…”