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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

 Ki Hong Kim  ;  Kang Su Cho  ;  Won Sik Ham  ;  Sung Joon Hong  ;  Kyung Seok Han 
 UROLOGY, Vol.86(3) : 459-464, 2015 
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Issue Date
Aged ; Digestive System Neoplasms/pathology ; Equipment Design ; Equipment Failure* ; Female ; Genital Neoplasms, Female/pathology ; Humans ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Risk Factors ; Self Expandable Metallic Stents* ; Ureteral Obstruction/etiology* ; Ureteral Obstruction/surgery*
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.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Hong(김기홍)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Han, Kyung Seok(한경석)
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
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