Long-Term Follow-Up of Yearly Replaced Double Internal Stents for Extrinsic Malignant Ureteral Obstruction

Savin, Ziv; Herzberg, Haim; Ben-David, Reuven; Dekalo, Snir; Mintz, Ishay; Marom, Ron; Barghouthy, Yazeed; Yossepowitch, Ofer; Sofer, Mario

doi:10.1089/end.2020.0469

Cited by 11 publications

(3 citation statements)

References 22 publications

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“…The median time to TUS failure was 7 months, which is slightly longer than other series published recently, which reported a 4-month median time to failure [ 31 , 32 ]. Median survival after TUS failure was 8 months, and median follow-up time was 17 months—which is longer than previous series [ 3 , 30 ], yet similar to more recent publications [ 31 , 33 ]. We believe that this indicates the improvement of systemic oncologic treatments for different malignancies in recent years, partially due to emerging novel immunotherapies, prolonging these patients’ life expectancy, and furthermore emphasizing the importance of effective urinary drainage for longer intervals.…”

Section: Discussionsupporting

confidence: 85%

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Carmona

Shvero

Zilberman

et al. 2023

JCM

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Background: Malignant ureteral obstruction (MUO) is a sequela of advanced malignant disease that requires renal drainage, with tandem ureteral stents (TUSs) being a viable option. This study aimed to evaluate the TUS failure rate, associated risk factors, and the feasibility of replacing failed TUSs with a new pair of stents. Methods: A retrospective analysis of MUO patients treated with TUS insertion from 2014 to 2022 was conducted. TUS failure was defined as urosepsis, recurrent urinary tract infections, acute kidney failure, or new hydronephrosis on imaging. Cox proportional hazard regression analysis identified the independent predictors of TUS failure. Results: A total of 240 procedures were performed on 186 patients, with TUS drainage failing in 67 patients (36%). The median time to failure was 7 months. Multivariate analysis revealed female gender (OR = 3.46, p = 0.002), pelvic mass (OR = 1.75, p = 0.001), and distal ureteral obstruction (OR = 2.27, p = 0.04) as significant risk factors for TUS failure. Of the failure group, 42 patients (22.6%) underwent TUS replacement for a new pair. Yet, 24 (57.2%) experienced a second failure, with a median time of 4.5 months. The risk factors for TUS second failure included a stricture longer than 30 mm (OR = 11.8, p = 0.04), replacement with TUSs of the same diameter (OR = 43, p = 0.003), and initial TUS failure within 6 months (OR = 19.2, p = 0.006). Conclusions: TUS insertion for the treatment of MUO is feasible and has good outcomes with a relatively low failure rate. Primary pelvic mass and distal ureteral obstruction pose higher risks for TUS failure. Replacing failed TUSs with a new pair has a success rate of 42.8%. Consideration should be given to placing larger diameter stents when replacing failed TUS.

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Section: Discussionsupporting

confidence: 85%

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Carmona

Shvero

Zilberman

et al. 2023

JCM

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“…In the clinical setting, the question of defining the ideal drainage option for patients with EUO has always been a subject of debate. While some urologists prefer single large diameter stent, 15 others use tandem stents [9][10][11] or metal stents. 16,17 The rationale for using tandem stents has relied on the theoretical advantage of two factorsone is the fact that two stents offer twice the cross-sectional area of single stent lumina, and the second is that a lumen is established that lies between the stents and the ureter wall (as seen in Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have focused on quantitative analysis of the impact of stent size and configuration (single, tandem) on volumetric flow in ureteral stents, whether in vivo, 1 ex vivo, 2 in vitro, 3,4 or in silico, [5][6][7][8] in the context of EUO or occlusion by ureteral stones. Moreover, tandem stent configurations have received particular attention as a potentially significant means to ensure drainage in the presence of EUO, [9][10][11] yet discussion continues over the preferred use of single or tandem configurations.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of in vitro urine flow in single and tandem stented ureters subject to extrinsic ureteral obstruction

et al. 2022

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Objective To quantify the relative volumetric flows in stent and ureter lumina, as a function of stent size and configuration, in both unobstructed and externally obstructed stented ureters. Methods Magnetic resonance imaging was used to measure flow in stented ureters using a phantom kidney model. Volumetric flow in the stent and ureter lumina were determined along the stented ureters, for each of four single stent sizes (4.8F, 6F, 7F, and 8F), and for tandem (6F and 7F) configurations. Measurements were made in the presence of a fully encircling extrinsic ureteral obstruction as well as in benchmark cases with no extrinsic ureteral obstruction. Results Under no obstruction, the relative contribution of urine flow in single stents is 1–10%, while the relative contributions to flow are ~6 and ~28% for tandem 6F and 7F, respectively. In the presence of an extrinsic ureteral obstruction and single stents, all urine passes within the stent lumen near the extrinsic ureteral obstruction. For tandem 6F and 7F stents under extrinsic ureteral obstruction, relative volumetric flows in the two stent lumina are ~73% and ~81%, respectively, with the remainder passing through the ureter lumen. Conclusions Magnetic resonance imaging demonstrates that with no extrinsic ureteral obstruction, minimal urine flow occurs within a stent. Stent lumen flow is significant in the presence of extrinsic ureteral obstruction, in the vicinity of the extrinsic ureteral obstruction. For tandem stents subjected to extrinsic ureteral obstruction, urine flow also occurs in the ureter lumen between the stents, which can reduce the likelihood of kidney failure even in the case of both stent lumina being occluded.

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Quality of life with tandem ureteral stents compared to percutaneous nephrostomy for malignant ureteral obstruction

Shvero

Haifler

Mahmud

et al. 2022

Support Care Cancer

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Long-Term Follow-Up of Yearly Replaced Double Internal Stents for Extrinsic Malignant Ureteral Obstruction

Cited by 11 publications

References 22 publications

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Magnetic resonance imaging of in vitro urine flow in single and tandem stented ureters subject to extrinsic ureteral obstruction

Quality of life with tandem ureteral stents compared to percutaneous nephrostomy for malignant ureteral obstruction

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