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

Abstract

ObjectiveTo evaluate predictive factors for retrograde ureteral stent failure in patients with non-urological malignant ureteral obstruction.Materials and methodsBetween 2005 and 2014, medical records of 284 malignant ureteral obstruction patients with 712 retrograde ureteral stent trials including 63 (22.2%) having bilateral malignant ureteral obstruction were retrospectively reviewed. Retrograde ureteral stent failure was defined as the inability to place ureteral stents by cystoscopy, recurrent stent obstruction within one month, or non-relief of azotemia within one week from the prior retrograde ureteral stent. The clinicopathological parameters and first retrograde pyelographic findings were analyzed to investigate the predictive factors for retrograde ureteral stent failure and conversion to percutaneous nephrostomy in multivariate analysis with a statistical significance of p < 0.05.ResultsRetrograde ureteral stent failure was detected in 14.1% of patients. The mean number of retrograde ureteral stent placements and indwelling duration of the ureteral stents were 2.5 ± 2.6 times and 8.6 ± 4.0 months, respectively. Multivariate analyses identified several specific RGP findings as significant predictive factors for retrograde ureteral stent failure (p < 0.05). The significant retrograde pyelographic findings included grade 4 hydronephrosis (hazard ratio 4.10, 95% confidence interval 1.39–12.09), irreversible ureteral kinking (hazard ratio 2.72, confidence interval 1.03–7.18), presence of bladder invasion (hazard ratio 4.78, confidence interval 1.81–12.63), and multiple lesions of ureteral stricture (hazard ratio 3.46, confidence interval 1.35–8.83) (p < 0.05).ConclusionRetrograde pyelography might prevent unnecessary and ineffective retrograde ureteral stent trials in patients with advanced non-urological malignant ureteral obstruction.

Predictors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction: systematic review and meta‐analysis

“…Seven studies reported on failure of endoscopic urinary diversion [3,8–14]. We found a failure rate of 32% (95% CI 21–45%; I 2 = 88%; Fig.…”

“…We found a total of 970 articles with the search strategies. Finally, nine studies met the inclusion criteria [3,[8][9][10][11][12][13][14][15] (Fig. 1).…”

“…We included nine retrospective cohort studies [3,[8][9][10][11][12][13][14][15], with a total of 761 patients and an average age of 60.5 years (Table 1). Failure was heterogeneous among the studies; however, most of them included failure within the first month.…”

Malignant upper urinary tract obstruction in cancer patients: A systematic review

“…Of these, 468 were excluded by title and abstract screening, and a further 189 were excluded after full‐text assessment. Of the studies screened, 82 met the study criteria and were included in this review 4–85 . Figure 1 illustrates the process.…”

Allium covered metal stent for treatment of malignant ureteral obstruction

“…The success rates of retrograde ureteral stents have improved steadily along the years, even so, the failure rates have been reported to be as high as 40% with the traditional single polymeric ureteral stents [15]. In addition to progression of the primary tumour, stent occlusion due to urine viscosity in combination with the aggregation of fragments and macromolecules is a frequent cause of stent failure [16,17], as are external compressive forces, mucous production, and urothelial sloughing.…”