Outcome of retrograde ureteric stenting as a urinary drainage procedure in ureteric obstruction related to malignant lesions

Wijayarathna, Suranga; Suvendran, S; Ishak, M.C.M.; Weligamage, A.; Epa, Apsara; Munasinghe, S; Abeyguneskera, AM

doi:10.4038/cmj.v59i4.7864

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…Some of the disadvantages of endoscopic urinary diversion are: regional or general anaesthesia, failure to pass, and catheter‐related morbidity (urinary symptoms, urinary sepsis, haematuria, and stone formation) [1]. Also, the patient’s quality of life might be compromised in terms of pain and low physical performance after endoscopic diversion, as reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Objective To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction. Methods We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino‐Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient’s health status. We performed a meta‐analysis using R software (‘meta’ and ‘metafor’ libraries). Results We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21–45%; I2 = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28–8.5; I2 = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32–7.52; I2 = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8–0.9; I2 = 0%). Conclusions We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.

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Section: Discussionmentioning

confidence: 99%

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

2020

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“…This is especially seen when patients are referred to a different unit to treat the same condition. Ideally, a formal agreement in the treatment plan should be reached after the input from all relevant specialities across different centers [27]. Formal pathways should be established for referrals and proper documentation should be given to the patients once treatment is completed and referred back [6].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…Treatments with minimal benefit can cause disproportionately more hardships to patients and their carers affecting the quality of life as well as becoming a financial burden [27]. As a country with a developing economy, we should always try to adopt cost-effective alternatives despite western guidelines and pressure from big pharma.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Cancer services in Sri Lanka: current status and future directions

Jayarajah

Abeygunasekera

2021

J Egypt Natl Canc Inst

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Background The burden of cancer in Sri Lanka is on the rise. The overall incidence of cancer in Sri Lanka has doubled over the past 25 years with a parallel rise in cancer-related mortality. Cancer has become the second commonest cause of hospital mortality in Sri Lanka. In this review, we aim to provide an overview of the current status and future direction of cancer care in Sri Lanka. Main body In Sri Lanka, cancer services are predominantly provided by the state sector free of charge to the general public. With the establishment of national cancer policy on cancer prevention and control, there has been a commendable improvement in the cancer services provided island-wide. An increasing number of breast, oropharyngeal, thyroid, oesophageal, colorectal, lung, and gastric cancers are being diagnosed and treated annually. Primary prevention measures include restrictions in tobacco and HPV vaccination. Screening programs for selected cancers such as breast, oral and cervical cancers are delivered. Medical oncology units with facilities for systemic therapy and adequately supported by surgical, pathology, and radiology departments have been established in each district general hospital island-wide. Although the current progress is commendable, future changes are necessary to overcome the current limitations and to cater the ever increasing burden of cancer. Measures are necessary to enhance the coverage of Sri Lanka Cancer Registry. Timely high-quality research and audits are essential. Community participation in planning strategies for cancer prevention and treatment is minimal. Community-based palliative care facilities and radiation and other systemic therapy should be made available in all provinces. A culture of multi-disciplinary care with proper referral pathways would help to improve the current setting. Conclusion In conclusion, Sri Lanka has a reasonably balanced and continuously expanding program for prevention, screening, and treatment of cancers. Emphasis on preventive strategies related to reducing tobacco smoking, chewing betel, and obesity, making cancers a notifiable disease, involving the community in planning cancer care and prevention strategies, conducting research to evaluate cost-effectiveness of existing treatment and increasing radiotherapy facilities would further improve the cancer services in Sri Lanka.

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“…Wijayarathna et al. [22] analyzed data on 82 patients who underwent retrograde ureteric stenting for ureteric obstruction related to malignant lesions. They determined elevated serum creatinine over 3 mg/dL and CT evidence of tumor recurrence in the pelvis ( p = 0.004 and p = 0.026, respectively) were indicators of poor outcome.…”

Section: Metallic Stents Vs Plastic Double J Stenmentioning

confidence: 99%

Stents for malignant ureteral obstruction

Pavlović

Lange

Chew

2016

Asian Journal of Urology

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Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS), tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical) and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical). In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes), or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

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Outcome of retrograde ureteric stenting as a urinary drainage procedure in ureteric obstruction related to malignant lesions

Abstract: Chances of successful RUS were low in patients with ureteric obstruction in the presence of tumour recurrences or elevated serum creatinine. Even if ureteric stenting was successful, their life expectancy was short.

Cited by 8 publications

References 7 publications

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

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

Cancer services in Sri Lanka: current status and future directions

Stents for malignant ureteral obstruction

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