Journal article
Factors Associated with Ureteral Stent Failure in Patients with Malignant Ureteral Obstruction
Journal of endourology, Vol.36(6), pp.814-818
06/2022
DOI: 10.1089/end.2021.0364
PMID: 35018790
Abstract
Management of malignant ureteral obstruction (MUO) with ureteral stents remains a clinical challenge, often involving frequent stent exchanges attributable to stent failure or other urological complications. We report our institutional experience with ureteral stents for management of MUO, including analysis of clinical factors associated with stent failure.
We performed a retrospective review of patients treated with indwelling ureteral stents for MUO in nonurothelial malignancies at our tertiary-care institution between 2008 and 2019. Univariate Cox proportional hazards analysis was performed to identify clinical variables associated with stent failure and stent-related complications. Stent failure was defined as need for unplanned stent exchange, placement of percutaneous nephrostomy (PCN), or tandem stents.
In our cohort of 78 patients, the median (range) number of stent exchanges was 2 (0-17) during a total stent dwell time of 4.3 (0.1-40.3) months. Thirty-four patients (43.6%) developed a culture-proven urinary tract infection (UTI) during stent dwell time. Thirty-five patients (44.8%) had stent failure. Twenty-two patients (28.2%) underwent unplanned stent exchanges, 23 (29.5%) required PCN after initial stent placement, and 6 (7.7%) required tandem stents. Ten (28.6%) patients with stent failure were treated with upsized stents, which led to resolution in seven patients. Stent failure occurred with 20/44 (45.4%) Percuflex™, 15/27 (55.6%) polyurethane, and 2/3 (66.7%) metal stents. In patients with ≥2 exchanges (
= 45), median time between exchanges was 4.1 (2.0-14.8) months. Bilateral stenting and history of radiation predicted UTI development. Median overall patient survival after initial stent placement was 19.9 months (95% CI 16.5-37.9 months).
Ureteral stent failure poses a significant medical burden to patients with MUO. Better methods to minimize stent-related issues and improve patient quality of life are needed. Using a shared decision-making approach, clinicians and patients should consider PCN or tandem stents early in the management of MUO.
Details
- Title: Subtitle
- Factors Associated with Ureteral Stent Failure in Patients with Malignant Ureteral Obstruction
- Creators
- Nicholas A Pickersgill - Washington University in St. LouisBrandoa Malik Wahba - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USAJoel M Vetter - Washington University in St. LouisSky J Cope - University of Missouri–Kansas CityNimrod S Barashi - Washington University in St. LouisGrant M Henning - Washington University in St. LouisKefu Du - Washington University in St. LouisRobert Sherburne Figenshau - Washington University in St. LouisAlana C Desai - Washington University in St. LouisRamakrishna Venkatesh - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.36(6), pp.814-818
- DOI
- 10.1089/end.2021.0364
- PMID
- 35018790
- NLM abbreviation
- J Endourol
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Language
- English
- Date published
- 06/2022
- Academic Unit
- Urology
- Record Identifier
- 9984949454502771
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