Long-term indwelling double-J stent for malignant ureteric obstruction: Tolerance and complications.

Abstract

170 Background: JJ stent is designed to be placed for short periods. In rare cases, long-term JJ can be considered particularly in malignant ureteric obstruction. The objective of this study was to assess tolerance and complications in patients with indwelling JJ. Methods: Data from consecutive patients who had a JJ stent placed for more than 6 months between 1992 and 2013 were analyzed. Patients were all followed in a single center where JJ stents were changed every 6 months or earlier in case of complications. Results: The study included 36 patients (22 female and 14 male). Mean age was 69.4 yrs. Median ASA 3 (IQ = 1). Mean creatinine before the 1st JJ 204 micromol/L (SD 232). Most frequent causes of obstruction were colorectal (30%), gynecological (25%) and prostate cancer (14%). In 7 cases, a bilateral JJ stent was placed. Median FU was 26.4 months. Median number of JJ changed per patient was 5.5 (IQ 6.0). Median duration for each JJ was 6 months (IQ 2.1). There was one case of broken stent and 5 cases of stent encrustation, all being managed endoscopically in a single procedure.Grade III-IV complications following theClavien-Dindo classification are reported in the table. All 17 deaths (47.2%) were related to cancer progression. Conclusions: Long-term complications related to indwelling JJ stents are not uncommon. However, we found that when changing the stent systematically every 6 months (or earlier in case of complications), and when taking into account the patient's situation (status/disease) that led to the indwelling JJ indication, tolerance and rate of complications were acceptable. [Table: see text]