Antegrade (AG) Versus Retrograde (RG) Stents for Ureteral Obstruction (UO) In Locally Advanced Cervical Cancer (CC) [3J

Abstract

INTRODUCTION: UO is common in patients with newly diagnosed CC. Management of UO commonly occurs with stent or nephrostomy placement (NT). The success rates for AG and RG stents amongst this group have not been reported. We sought to document performance of these procedures to inform comparative effectiveness studies. METHODS: Medical records of patients with locally advanced CC and UO treated at our institution between 2000 - 2009 were reviewed. Failure of a procedure was defined as worsening hydronephrosis on imaging, rising creatinine, or need for an alternate method of management. RESULTS: 55 patients with stage IIIA-IVA CC were identified. Stages at presentation were 13% (IIIA), 60% (IIIB), and 27% (IVA). Fifty-one percent of patients presented with UO and 93% of these underwent a procedure. Fifty-four percent had attempted AG stent placement while 46% had attempt at RG stent. Thirty-eight percent of patients failed initial stent attempt: 50% failed via AG approach and 20% via RG. Amongst successful placement, mean number of follow up procedures secondary to stent failure was 3. Median stent survival was 120 days. Thirty percent of patients required long term management of UO with NT placement. Failure of UO management following NT placement was 0%. CONCLUSION: High short and long-term failure rates were seen with both AG and RG approaches and required multiple follow up procedures to manage UO. NT was most successful for long term management of UO. Given this, NT may be a reasonable initial management strategy for advanced stage CC with UO.