A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab

Alessio Tognarelli,Cesare Selli,Francesca Manassero,Angiolo Gadducci,Lorenzo Faggioni

doi:10.1186/s12894-019-0566-1

Alessio Tognarelli, Cesare Selli + Show 3 more

Open Access

https://doi.org/10.1186/s12894-019-0566-1

Copy DOI

Journal: BMC Urology	Publication Date: Dec 1, 2019
Citations: 8	License type: open-access

Affiliation: University of Pisa

Abstract

BackgroundThe angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors.Case presentationWe describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan.ConclusionsSince Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.

Highlights

The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing
Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers
The final analysis of a large randomized prospective trial on the use of Bevacizumab in women with advanced cancer of the cervix, demonstrated an advantage in the overall survival rate compared to chemotherapy alone (16.8 vs 13.3 months) and an increased risk of fistula formation (15% vs 1%) [2]

Summary

Conclusions

Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.

Background

Findings

Discussion and conclusions