The outcome with ureteric stents for managing non‐urological malignant ureteric obstruction

Abstract

OBJECTIVE To investigate the clinical outcome using ureteric stents to manage ureteric obstruction in advanced non‐urological malignancies. PATIENTS AND METHODS We retrospectively reviewed the use of ureteric stents (Endo‐sof, Cook Urological, Spencer, IN, USA) placed for malignant ureteric obstruction from June 2001 to September 2006. The clinical and radiological variables for predicting the failure of stent insertion, functional stent failure and death were analysed. RESULTS In all, 86 patients with a non‐urological malignant ureteric obstruction were treated by ureteric stenting; 13 (15%) had failure of retrograde stent insertion, and of the remaining 73, 12 (16%) had stent failures during the subsequent follow‐up. The risk of failure for stent insertion significantly increased with male gender (hazard ratio 6.45, P = 0.028) and the presence of bladder invasion (hazard ratio 27.04, P < 0.001). There was no independent predictor of stent failure in univariate analysis. Of the 86 patients, 54 (63%) died with a mean survival time of 8.6 months after an initial attempt to place a stent, and 41 (48%) died within 1 year. Multivariate analysis showed that low performance status, upper ureteric obstruction and no chemotherapy after stenting were independently associated with a poor prognosis (P = 0.03, 0.004 and 0.003, respectively). CONCLUSION The method of diversion for a malignant ureteric obstruction should be carefully discussed with male patients or if there is bladder invasion. Patients with a low performance status, upper ureteric obstruction and no scheduled chemotherapy after stenting had a poor survival time.

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

“…To date, there is no consensus regarding the correct management of MUO (8,13,14). The use of ureteral stents to bypass the obstruction is common in clinical practice, and RUS is more advantageous than PCN, particularly in view of the limited life expectancy of patients with advanced malignancies (3,4,7).…”

“…77.340). Jeong et al (14) retrospectively reviewed the use of ureteric stents placed for 86 patients with a non-urological MUO, and found that 13 (15%) experienced failure of retrograde stent insertion, and that the risk of failure for stent insertion significantly increased with the presence of bladder invasion (OR, 27.04; P<0.001). Ganatra and Loughlin (11) analyzed 157 patients with MUO who underwent retrograde ureteral stent placement, and found that when invasion into the bladder was noted on cystoscopy, 55.9% (19/34; P=0.008) developed stent failure.…”

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

“…For example, obstruction from bladder, prostate, or cervical cancer has been found more difficult to manage by retrograde stenting; on the contrary, stent placement in patients with colorectal and breast cancer is much more effective. 3,50,51 There is enough evidence to support the conclusion that percutaneous tube placement should probably be a wiser option for the treatment of patients with upper-tract obstruction from pelvic malignancies.…”

“…50 A recent retrospective study from Korea looked into the efficacy of retrograde stent placement for the management of nonurologic malignancies, mainly metastatic gastric cancer. 51 Initial failure of stent insertion occurred in 15% of cases, while stent-change therapy failed for another 16% of patients within a median time of 3.2 months. Only 7% of patients had significant improvement after therapy to allow safe removal of the ureteral stent.…”

“…Retrograde insertion of a stent has been technically successful in an average of 85% of cases, considering results from recent series as depicted in Table 1. 8,31,41,44,[49][50][51] This shift can be attributed to improvement in stent insertion techniques and refinement in stent and guidewire design and stent material biocompatibility.…”