Stent failure in the management of malignant extrinsic ureteral obstruction: Risk factors

Kamiyama, Yoshimi; Matsuura, Shinobu; Kato, Masanori; Abe, Yuko; Takyu, Shunichi; Yoshikawa, Kazuyuki; Arai, Yoichi

doi:10.1111/j.1442-2042.2011.02731.x

Cited by 33 publications

(41 citation statements)

References 12 publications

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“…3.597) predicted the failure of retrograde stenting, and the failure rate was 66.7%. These results were in agreement with those of the study by Kamiyama et al (3). Such patients have more advanced tumor staging and their general health is poorer (10).…”

Section: Discussionsupporting

confidence: 83%

“…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). However, the incidence of insertion failure is markedly higher in cases of MUO, ranging from 15.0 to 27.5% (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). This high failure rate may be associated with extrinsic compression or invasion of the ureter by tumors, which may lead to the bending and deformation of the ureter, which then increases resistance during intubation in the majority of advanced malignancies (15).…”

Section: Discussionmentioning

confidence: 99%

“…Stent failure was defined as any ureteral unit (UU) in which stent insertion failed or any UU that continued to cause symptoms for the patient after stent placement (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Stents were inserted by three experienced urological surgeons on an outpatient basis, using local anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…The advantages of this procedure are its simplicity and convenience, with no requirement for hospitalization, and a cheaper cost. However, cystoscopic ureteral stent insertion is a challenging procedure even for the most experienced urologists, with a mean failure rate of 15.0-27.5% (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Abstract. Malignant ureteral obstruction (MUO) is an unpropitious sign that is commonly observed in patients with advanced incurable cancer. The present study aimed to evaluate predictive factors for the failure of retrograde ureteral stent insertion in the management of MUO in outpatients. A total of 164 patients with MUO were retrospectively assessed in this study. Clinical factors, including age, gender, type of malignancy, level of obstruction, cause of obstruction, pre-operative creatinine level, degree of hydronephrosis, condition of the contralateral ureter, prior radiotherapy, Eastern Cooperative Oncology Group performance status (ECOG PS), bladder wall invasion and technical failure, were recorded for each case. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for predicting the failure of retrograde ureteral stent insertion. In total, 38 out of 164 patients experienced bilateral obstruction, therefore, a total of 202 ureteral units were available for data analysis. The rate of insertion failure in MUO was 34.65%. Multivariate analyses identified ECOG PS, degree of hydronephrosis and bladder wall invasion as independent predictors for insertion failure. Overall, the present study found that rate of retrograde ureteral stent insertion failure is high in outpatients with MUO, and that ECOG PS, degree of hydronephrosis and bladder invasion are potential independent predictors of insertion failure.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…MUO is caused by direct invasion of the tumor, lymph node metastasis, and abdominal dissemination. Park et al22 and Kamiyama et al23 previously reported on the decreased effectiveness of polymeric ureteral stents in cases of disseminated cancer, such as in the case of gastric tumors which disturb ureteral peristalsis. Chow et al13 investigated radiological features as possible risk factors for metallic stent failure in a relatively large cohort, providing evidence that abdominal ureteral obstruction and lymphatic metastasis around the ureter were associated with shorter functional duration.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of ureteral stenting for malignant extrinsic ureteral obstruction: a comparison between polymeric and metallic stents

Asakawa¹,

Iguchi²,

Tamada³

et al. 2018

CMAR

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PurposeTo compare treatment outcomes, more specifically patency rate, of polymeric and metallic stents for malignant ureteral obstruction.Patients and methodsBetween August 2007 and September 2017, we retrospectively analyzed the data of 92 patients (126 ureters) having a diagnosis of malignant extrinsic ureteral obstruction treated with indwelling ureteral stents (polymeric and full-length metallic stents). Of these patients, 35 (54 ureters) were treated with polymeric stents and 57 (72 ureters) with a Resonance® metallic stent. The observation period was censored to 1 year. Survival rate in cases of malignant ureteral obstruction was calculated, and the relationship between the causes of ureteral obstruction, the stent type, and the patency rate was evaluated.ResultsThe median observation period was 145 days, with a median survival time of 258 days. The stent patency rate was 70.9% at 1 year, regardless of stent type. Stent occlusion was observed in 20 patients (33 ureters). According to stent type, occlusion of the polymeric and metallic stents was identified in 12 (22%) and 8 (11%) cases, respectively. The clinical features associated with stent failure were assessed. In univariate analysis, the patency rate was significantly better for the metallic stent than for the polymeric stent (1-year patency rate; 78.4%, 61.1%, respectively, HR, 2.15; 95% CI, 1.07–4.33; p=0.031). However, the patency rate among patients with abdominal dissemination, lymph node metastasis, and direct compression by tumor was not significantly different.ConclusionIndwelling ureteral stents, particularly metallic stents, are effective for the treatment of malignant ureteral obstruction.

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Malignant upper urinary tract obstruction in cancer patients: A systematic review

Shah,

Blest,

Blackmur

et al. 2024

BJUI Compass

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ObjectiveTo systematically summarise the current clinical evidence for de novo malignant upper urinary tract obstruction treatment with a focus on standards of reporting, patient outcomes and future research needs.MethodsThis review protocol was published via PROSPERO (CRD42022341588). OVID MEDLINE (R), EMBASE, Cochrane Central Register of Controlled Trials—CENTRAL were searched up to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses. Prospective and retrospective studies were included.ResultsOf 941 articles identified, 82 with 8796 patients were eligible for inclusion.Most studies in the published literature are retrospective and investigate heterogenous malignancies. Percutaneous nephrostomy and ureteric stenting are the most studied interventions. Few studies describe the outcomes from no intervention or investigate patient perspectives. Overall reported median survival after intervention was around 11.7 months. A lack of standardised reporting of outcomes was evident.ConclusionsMalignant upper urinary tract obstruction is an important clinical condition affecting patients globally. Overall survival after intervention appears poor however the current evidence base has significant limitations due to studies of low methodological quality and the lack of a standardised framework for reporting outcomes.We have provided a pragmatic framework for future studies based on the review to ensure a uniform methodology is utilised moving forward.

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Stent failure in the management of malignant extrinsic ureteral obstruction: Risk factors

Cited by 33 publications

References 12 publications

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

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

Treatment outcomes of ureteral stenting for malignant extrinsic ureteral obstruction: a comparison between polymeric and metallic stents

Malignant upper urinary tract obstruction in cancer patients: A systematic review

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