Stent-Change Therapy in Advanced Malignancies with Ureteral Obstruction

Abstract

Stent-change therapy is an efficacious way to treat patients with advanced malignancies and ureteral obstruction, many of whom have a short life expectancy. All patients maintained adequate renal function to obviate dialysis. Most patients with stents in place will die before their renal function deteriorates. They may also benefit from treatment strategies designed to avoid the occurrence of frequent urinary infections.

Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

“…In addition, invasion of the ureter by cervical, ovarian, bladder, prostate or colorectal cancer can cause MUO. Once an obstruction occurs, it may progress to renal insufficiency with the appearance of an electrolyte imbalance, uremia or a life-threatening urinary tract infection, and effective management must be scheduled, particularly if further chemotherapy is planned or required (1,2).…”

“…In the majority of developing countries, such as China, due to a large population base and limited medical resources, cystoscopic RUS under local anesthesia is first attempted in such patients prior to other methods (1,2). The advantages of this procedure are its simplicity and convenience, with no requirement for hospitalization, and a cheaper cost.…”

Endourologic Management of Malignant Ureteral Obstruction: Indications, Results, and Quality-of-Life Issues

“…Given that the median survival for these patients usually does not exceed 1 year, prolonging survival by preventing death from uremia may come with the price of reduced quality of life because of pain, fatigue, or other sequellae of advanced metastatic disease. 2,3,[5][6][7][8][9][10] Therefore, it is debatable whether urinary diversion by means of internal stent or nephrostomy catheter placement offers some benefit for cancer patients with life-threatening comorbidities unless it facilitates or follows certain therapeutic anticancer treatment. 5,[11][12][13][14] In any other case, the patient's right to a peaceful death from uremia when there is no hope for cure or palliation should be taken into account when concerns are raised regarding quality of life during those final days.…”

“…Also, the limited survival of these patients made major surgical reconstruction unattractive and questionably ethical; less invasive options were sought. 8 With the advent of minimally invasive surgery, a plethora of endourologic techniques was introduced for the management of malignant ureteral strictures with divergent results. Percutaneous ureteroneocystostomy with antegrade stent placement was considered an alternative to open procedures with reasonable and durable results.…”

Early Application of Permanent Metallic Mesh Stent in Substitution for Temporary Polymeric Ureteral Stent Reduces Unnecessary Ureteral Procedures in Patients With Malignant Ureteral Obstruction

“…Ureteral stenting can relieve the obstruction by malignant compression and protect renal function in patients with extrinsic MUO. 1 To date, polymeric double J (PDJ) stents have been those most commonly used, because their placement and removal are relatively easy and safe to perform during a cystoscopic procedure without general anesthesia. 2 An indwelling PDJ stent has become widely accepted as the initial step to manage non-urological MUO.…”