Gastrointestinal cancer and bilateral hydronephrosis resulted in a high risk of ureteral stent failure

Abstract

BackgroundUrologists frequently encounter malignant ureteral obstruction (MUO) caused by advanced urological or non-urological malignant disease, but the treatment policy is unclear. The present study examined the risk factors for predicting ureteral stent failure in patients with MUO after ureteral stent insertion and the change in the renal function after retrograde ureteral stent insertion in cases of bilateral hydronephrosis.MethodsA total of 39 patients who required ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, Japan) between February 2007 and May 2016 were included in this study. The age, gender, type of cancer, hydronephrosis side, pre-stenting estimated glomerular filtration rate (eGFR), and eGFR increase were assessed as predictive factors for stent failure. Among these 39 patients, 25 showed bilateral hydronephrosis. Thirteen of these patients had bilateral ureteral stents placed, and the remaining 12 had a unilateral ureteral stent placed. The renal function and overall survival (OS) were analyzed between these two groups.ResultsAmong all 39 patients, 9 (23.1%) had stent failure. A univariate analysis revealed that causative disease (gastrointestinal cancer vs. others; p = 0.045) and laterality of hydronephrosis (bilateral vs. unilateral; p = 0.05) were associated with stent failure. A multivariate analysis revealed that only age (hazard ratio, 0.938; 95% confidence interval, 0.883–0.996; p = 0.038) was associated with stent failure. A Kaplan-Meier analysis and log-rank test indicated that having a unilateral ureteral stent placed was not correlated with a lower OS rate than having bilateral ureteral stents placed (p = 0.563). Among patients with bilateral hydronephrosis, the increase in the eGFR of those who had bilateral ureteral stents placed was not significantly different from that of those who had a unilateral ureteral stent placed (p = 0.152).ConclusionsWe revealed that age > 60 years was helpful for predicting stent failure. MUO due to gastrointestinal cancer and bilateral hydronephrosis may be predictive of stent failure. These factors may help urologists decide the optimal time to perform early percutaneous nephrostomy. These findings suggest that patients with bilateral hydronephrosis do not necessarily need to have a ureteral stent placed into both sides of the hydronephrosis.

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

“…Nonetheless, we know the intrinsic and extrinsic conditions, such as urogenital, gynaecological, and colorectal neoplasms [2]. If left untreated, a progressive obstruction can lead to impaired renal function, uraemia, electrolyte imbalance, UTIs, and low back pain [3]. These patients require active intervention, especially if chemotherapy is required [4].…”

“…Accordingly, the first treatment option is placing a retrograde ureteric catheter. However, the rate of catheter failure is high, with a failure rate range of between 12.2% and 34.6% [3]. Therefore, in the present study, we aimed to determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction.…”

Inserting a Metallic Ureteral Stent Using an Antegrade Approach Freed a Patient from Nephrostomy Created due to Hydronephrosis Caused by Bladder Cancer

“…For ureteral stenosis or obstruction, a ureteral stent is usually selected first over percutaneous nephrostomy due to its low invasiveness and lower frequency of scheduled exchange [2]. However, for severe external ureteral stent obstruction or bladder invasion of severe malignant diseases, percutaneous nephrostomy is initially chosen.…”

“…Metallic ureteral stents are effective for managing ureteral obstruction or stenosis induced by advanced malignant diseases [1]. In most cases, retrograde ureteral stent insertion is attempted first, but for cases of internal ureteral orifice invasion, nephrostomy is sometimes chosen for the initial treatment [2, 3].…”

Bilateral Encrusted Metallic Stent Successfully Removed by Ureteroscopic Lithotripsy Using a Ho:YAG Laser in a Patient with Malignant Myeloma

“…We previously reported the usefulness of ureteral stenting in the treatment of malignant ureteral obstruction (MUO) and that hematological disease was responsible for 2.6% of all cases of MUO [ 2 , 3 ]. In malignant myeloma, steroid treatment is sometimes introduced with systemic chemotherapy.…”