Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Abstract

Cervical cancer is the 3rd most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P<0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.