Predicting the Success of Retrograde Stenting for Managing Ureteral Obstruction

Yossepowitch, Ofer; Lifshitz, David A.; Dekel, Yoram; Groß, Michael; Keidar, Dani M.; Neuman, Menahem; Livne, Pinhas M.; Baniel, Jack

doi:10.1016/s0022-5347(05)65666-2

Cited by 140 publications

(67 citation statements)

References 8 publications

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“…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). 8 Taken together, these findings underscore the need for novel therapeutic approaches for MUO.…”

Section: Discussionmentioning

confidence: 89%

“…18 Failure rates for traditional polyurethane based stents in MUO range from approximately 35% to 45%. [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.…”

Section: Discussionmentioning

confidence: 95%

“…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%

“…This outcome is comparable to the 35% to 45% failure rates historically observed with traditional polyurethane based stents for MUO. [7][8][9] Patients with prostate cancer with malignant bladder invasion on cystoscopy are at significantly higher risk for failure. These observations warrant confirmation in randomized prospective clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…3 Unfortunately failure rates of 35% to 45% have been reported for traditional polyurethane ureteral stents in MUO. [7][8][9] A metallic coiled Double-J® ureteral stent manufactured from a nickelcobalt-chromium-molybdenum alloy was recently developed (Resonance®, Cook Medical, Bloomington, Indiana). This stent has a reported dwell time of up to 12 months and has been used clinically since 2006.…”

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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: Discussionmentioning

confidence: 89%