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Early Application of Permanent Metallic Mesh Stent in Substitution for Temporary Polymeric Ureteral Stent Reduces Unnecessary Ureteral Procedures in Patients With Malignant Ureteral Obstruction

Authors
 Ki Hong Kim  ;  Kang Su Cho  ;  Won Sik Ham  ;  Sung Joon Hong  ;  Kyung Seok Han 
Citation
 Urology, Vol.86(3) : 459-464, 2015 
Journal Title
 Urology 
ISSN
 0090-4295 
Issue Date
2015
Abstract
OBJECTIVE: To identify risk factors for metal stent failure in patients who received polymeric double J (PDJ) ureteral stents for malignant ureteral obstructions (MUOs) and review our clinical experiences using a ureteral metallic stent. PATIENTS AND METHODS: Patients who underwent metallic stent placement to replace a double J ureteral stent for nonurological MUO between January 2011 and February 2014 were included. The collected data included gender, age, laterality, cause of obstruction, PDJ ureteral stenting duration, immediate success of the metal stent, and additional procedures to relieve obstruction after metal stenting (eg, additional metal stenting or percutaneous nephrostomy (PCN) indwelling catheter placement). Cox regression tests were used for the statistical analyses. RESULTS: In this analysis 40 ureteral units were included. There was no initial technical failure. However, 9 (22.5%) units required additional procedures due to de novo ureteral obstruction, including additional indwelling metal stents (7.5%), additional PDJ stenting (10%), or indwelling percutaneous nephrostomy (5%). Univariate and multivariate analyses revealed that the duration of previous PDJ ureteral stenting was an independent prognostic factor for predicting ureteral metal stent failure (hazard ratio = 1.063, 95% confidence interval = 1.004-1.125; P = .037). CONCLUSION: Long-term indwelling of a PDJ ureteral stent increases the risk of additional management for de novo ureteral stricture after ureteral metal stent replacement for nonurological MUO. Our data suggest that careful patient selection and counseling for those at high risk are needed when metal stent replacement is considered for patients with long-term PDJ ureteral stents for MUO.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141553
DOI
10.1016/j.urology.2015.06.021
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실)
Yonsei Authors
김기홍(Kim, Ki Hong) ; 조강수(Cho, Kang Su) ; 한경석(Han, Kyung Seok) ; 함원식(Ham, Won Sik) ; 홍성준(Hong, Sung Joon)
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Full Text
http://www.sciencedirect.com/science/article/pii/S0090429515006172
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