Treatment Of Malignant Ureteral Obstruction Research Articles

Allium ureteral stent for the treatment of malignant ureteral obstruction: A median term study.

This study aimed to assess the safety and efficacy of Allium ureteral stents for the maintenance therapy of malignant ureteral obstruction (MUO). Clinical data of 25 patients (27 sides) with ureteral obstruction caused by a malignant tumor from December 2018 to December 2021 were retrospectively analyzed. Preoperative ultrasonography and computed tomography urography indicated hydronephrosis and MUO. Allium ureteral stents were placed using a retrograde or antegrade approach. Therapeutic effects and complications were recorded. The Wilcoxon signed-rank test was used to compare continuous variables between the preoperative and the last follow-up. A total of 25 patients (27 sides) were included in this study. After a follow-up time of 18 (11-29) months, the width of hydronephrosis [1.6 (1.0-2.2) cm vs 2.6 (1.2-3.3) cm, P = .000], glomerular filtration rate [83.8 (58.1-86.4) mL/minutes/1.73 m2 vs 74.5 (56.8-79.1) mL/minutes/1.73 m2, P = .001] and score of ureteral stent symptoms questionnaire [77 (76-79) vs 100 (98-103), P = .000] was significantly improved. Stent migration occurred in 3 of the 25 patients within 3 months after surgery. All patients with complications were followed up for at least 6 months after stent adjustment or exchange, and no other complications were found. Two patients died because of malignant complications. The stent patency rate was 88.9% (24/27) after the first operation, and 100% (27/27) after complications were treated. The Allium ureteral stent is safe and effective for the maintenance therapy of MUO, which can dramatically relieve the symptoms of patients. Stent migration is a major complication that can be resolved by endoscopic adjustment.

Antegrade placement of JJ catheter in the treatment of malignant ureteral obstruction: Retrospective analysis of a single centre

Objective: The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible. Methods: In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined. Results: In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes. Conclusions: Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.

Bilateral Double-Pigtail Ureteral Stent Placement for Management of Ureteral Obstruction Secondary to Transitional Cell Carcinoma in a Dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portion of the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both. Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated with morbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting from a variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignant ureteral obstruction and long-term follow-up in a dog.Case: An 11‐year‐old female spayed Maltese with ureteral obstruction secondary to transitional cell carcinoma (TCC) in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment, recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall local tumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stent of appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to 32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. The correct location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventful and the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after original presentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was related to the bone metastasis.Discussion: Ureteral stent placement is feasible techniques for treatment of bladder TCC in dogs, with the objective of delaying the evolution of the disease and preventing ureteral obstruction. According to previous studies, although distant metastatic disease is worrisome, in the majority of dogs with bladder TCC, the primary location of the tumor is the most common cause of death. In patients with ureteral obstruction, early intervention preserves functional renal tissue. Thus, relief of obstruction should be recommended as soon as possible before irreversible renal damage occurs. The authors encourage aggressive and timely intervention, particularly when ureteral obstruction is bilateral. In the present report, 90 days postoperatively local recurrence causing ureteral obstruction was not evidenced on bladder ultrasound images and laboratory test follow-up. After this period, until 180 days after debulking surgery, tumor recurrence occurred, causing clinical signs and compromising renal function. Complications associated with stent placement included stent migration, recurrent ureteral obstruction, stranguria/pollakiuria, presumably due to irritation of the trigonal region from the distal stent; imperfect stent location; ureteral trauma during stent placement; and urinary tract infection. In the present report, the ureteral stents were placed for palliative treatment for malignant ureteral obstructions. Although urinary tract infection was recurrent, other complications associated with bilateral ureteral stent did not occur, such as accidental dislocation or stent obstruction by the tumor. The results obtained were satisfactory for urinary tract obstruction, allowing survival of 517 days. These findings may support long-term ureteral stenting in veterinary patients.

Antegrade insertion of a double J catheter in the treatment of malignant ureteral obstruction: a retrospective analysis of the results obtained with a modified technique at a university hospital.

ObjectiveTo analyze the results obtained with a modified antegrade double J catheter insertion (JJ stenting) technique in patients with urinary tract obstruction due to malignancy.Materials and MethodsThis was a retrospective analysis of data collected from patients undergoing antegrade JJ stenting for malignant ureteral obstruction in the interventional radiology department of our institution between March 1, 2017 and May 31, 2019.ResultsAntegrade JJ stenting was performed in 32 patients (20 women and 12 men). The mean age was 66.2 years among the females and 61.5 years among the males. A total of 53 antegrade JJ stenting procedures were performed. The procedure was successful in 50 cases and failed in 3 (due to migration of the double J catheter in 2 and due to technical failure in 1). Complications occurred in 3 patients (low back pain, in 1, subcapsular hematoma, in 1, and pyelonephritis, in 1). The procedure time ranged from 14 min to 55 min.ConclusionIn patients with ureteral obstruction due to malignancy, antegrade JJ stenting is safe and effective. The technique selected in our study is easily reproduced and can be performed by a trained professional.

The resonance\xae metallic ureteral stent in the treatment of malignant ureteral obstruction: a prospective observational study

BackgroundTo study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO.MethodsAll patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever).ResultsAlthough stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients’ median age was 67 years (range 28–85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16–372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women’s IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women’s total score tended to be low, the difference between the men’s and women’s scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative.ConclusionMetallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.

Clinical application of fluoroscopic guided percutaneous antegrade ureteral stents placement for the treatment of malignant ureteral obstruction.

To investigate the clinical efficacy and safety of fluoroscopic guided percutaneous antegrade ureteral stents placement used for treatment of malignant ureteral obstruction. Between April 2016 and March 2018, fluoroscopic guided percutaneous ureteral stents was performed in 25 patients, including 7 patients (28%) with bilateral obstruction. The most common cancer diagnoses were cervical cancer (28%), rectal cancer (24%) and colon cancer (16%) among these patients. Clinical data were retrospectively analyzed with respect to the efficacy, safety and outcome of this treatment method. Percutaneous antegrade placement of ureteral stents was performed in all cases, including 12 ureters that failed in the initial retrograde ureteral stents placement. The median stent patency time for the antegrade ureteral stents were 10.4 (95% CI: 8.3-12.6) months. The primary complications included mild flank pain and discomfort (44%), hematuria (44%), urinary tract infection (8%), bladder irritation symptoms (4%), and arterial bleeding (4%). Fluoroscopic guided percutaneous ureteral stents placement is a safe, efficient procedure and has a high success rate in patients with malignant ureteral obstruction.

Treatment outcomes of ureteral stenting for malignant extrinsic ureteral obstruction: a comparison between polymeric and metallic stents.

PurposeTo compare treatment outcomes, more specifically patency rate, of polymeric and metallic stents for malignant ureteral obstruction.Patients and methodsBetween August 2007 and September 2017, we retrospectively analyzed the data of 92 patients (126 ureters) having a diagnosis of malignant extrinsic ureteral obstruction treated with indwelling ureteral stents (polymeric and full-length metallic stents). Of these patients, 35 (54 ureters) were treated with polymeric stents and 57 (72 ureters) with a Resonance® metallic stent. The observation period was censored to 1 year. Survival rate in cases of malignant ureteral obstruction was calculated, and the relationship between the causes of ureteral obstruction, the stent type, and the patency rate was evaluated.ResultsThe median observation period was 145 days, with a median survival time of 258 days. The stent patency rate was 70.9% at 1 year, regardless of stent type. Stent occlusion was observed in 20 patients (33 ureters). According to stent type, occlusion of the polymeric and metallic stents was identified in 12 (22%) and 8 (11%) cases, respectively. The clinical features associated with stent failure were assessed. In univariate analysis, the patency rate was significantly better for the metallic stent than for the polymeric stent (1-year patency rate; 78.4%, 61.1%, respectively, HR, 2.15; 95% CI, 1.07–4.33; p=0.031). However, the patency rate among patients with abdominal dissemination, lymph node metastasis, and direct compression by tumor was not significantly different.ConclusionIndwelling ureteral stents, particularly metallic stents, are effective for the treatment of malignant ureteral obstruction.

Palliative Care of Malignant Ureteral Obstruction with Polytetrafluoroethylene Membrane-Covered Self-Expandable Metallic Stents: Initial Experience

PurposeWe assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results.Materials and MethodsEighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure.ResultsThe mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain.ConclusionsUVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.

Use of indwelling, double-pigtail stents for treatment of malignant ureteral obstruction in dogs: 12 cases (2006–2009)

To determine the outcome of minimally invasive ureteral stent placement for dogs with malignant ureteral obstructions. DESIGN-Retrospective case series. 12 dogs (15 ureters) with ureteral obstruction secondary to a trigonal urothelial carcinoma. In all patients, indwelling, double-pigtail ureteral stents were placed by means of percutaneous antegrade needle and guide wire access under ultrasound and fluoroscopic guidance. Stents were successfully placed in all patients. In 11 of 12 patients, percutaneous antegrade access was accomplished. One patient required access via laparotomy because percutaneous access could not be achieved. The median survival time from the date of diagnosis was 285 days (range, 10 to 1,571 days), with a median survival time of 57 days (range, 7 to 337 days) from the date of stent placement. Three complications occurred in 1 patient. Seven patients required concurrent urethral stent placement for relief of urethral obstruction. All animals were discharged from the hospital (median hospitalization time after stent placement, 18 hours [range, 4 hours to 7 days]) with an indwelling, double-pigtail ureteral stent (3 bilateral and 9 unilateral) in place. All stents evaluated 0.25 to 11 months after placement were considered patent. Findings suggested that ureteral stent placement was safe, effective, and well tolerated in patients with malignant ureteral obstructions. Stents could be reliably placed in a minimally invasive manner and remain patent long-term. Ureteral stent placement should be considered as early as possible in patients with neoplasia, prior to the development of permanent renal damage.

MP-04.06: Treatment of Malignant Ureteral Obstruction with Ureteral Stents Offers a High Risk for Microbial Device Colonisation

MP-04.06: Treatment of Malignant Ureteral Obstruction with Ureteral Stents Offers a High Risk for Microbial Device Colonisation

Application of Self-Expandable Metal Stents for Ureteroileal Anastomotic Strictures: Long-Term Results

We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents. A total of 16 male and 2 female patients with a mean+/-SD age of 72+/-7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture. The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation. Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.

Metal Stents: A New Treatment of Malignant Ureteral Obstruction

Purpose We report our experience with the use of metallic self-expandable and balloon expandable stents for the treatment of malignant ureteral obstruction. Materials and Methods We treated 12 consecutive patients with malignant ureteral obstruction, for a total of 14 ureters with stents placed. We placed metallic balloon expandable stents in 6 patients and self-expandable metallic stents in the remaining 6. Mean patient age was 65 years and mean followup was 9 months (range 8 to 16). Results Of the ureters 11 were patent without any additional manipulations during followup of 8 to 16 months. Secondary interventions were needed in 3 cases because of obstructive urothelial hyperplastic reaction, tumor ingrowth and local recurrence of the primary cancer invading the upper end of the stent. Two patients died 2 and 10 months after placement of the stent. Conclusions Both types of metal stents have advantages and disadvantages that must be balanced against each other when choosing the ideal device for the treatment of obstruction. Implantation of a metal self-expanding or balloon expanding stent is safe and effective for the palliative treatment of malignant ureteral obstruction in late stage cancer patients.

Wallstents for the treatment of extrinsic malignant ureteral obstruction: midterm results.

To test the clinical efficacy of metal stents in the treatment of malignant ureteral obstruction and to maximize the effectiveness of the method. Fifty-four malignant stenoses of the ureter were treated in 40 patients by implantation of a self-expandable permanent endoluminal stent (SPES). The mean follow-up time was 10.5 months (range, 1-44 months). Recanalization was possible in all but one ureter. Fifty-one ureters were kept sufficiently open during the follow-up period. Fifty-one percent needed no further intervention, whereas 49% needed reintervention to reestablish patency. Three ureters in the latter group finally had to be abandoned. The primary patency after 12 months was 31% according to the Kaplan-Meier estimation. The survival rates of the patients were 40% after 12 months and 22% after 24 months and were unrelated to stent placement. Since no major complications occurred and hydronephrosis and its sequelae could be prevented in most cases during the observation period, the authors conclude that the implantation of a SPES into the ureter is a safe and effective method for the palliative treatment of tumor-associated ureteral strictures.

Self-expanding metal stents for palliative treatment of malignant ureteral obstruction.

We studied the immediate and long-term efficacy of the Wallstent device in the treatment of ureteral obstruction caused by malignant disease. In 23 patients (30 ureters), self-expanding metal stents were implanted endoscopically (n = 23), percutaneously (n = 5), or bidirectionally (n = 2) because of extrinsic malignant ureteral obstruction. Patients who met the following criteria were selected for stent implantation: (1) life expectancy of at least 6 months, (2) current polychemotherapy, (3) increasing levels of serum creatinine, and (4) severe clinical signs and symptoms associated with hydronephrosis. Obstruction was diagnosed by using sonography and excretory urography. After radiologic localization and dilatation of the stenosis, the Wallstent device was inserted. For 4 weeks, a double-J catheter inserted through the stent was kept in place in order to prevent obstruction by reversible hyperplastic reaction of the urothelium. Patients were followed up for 31 weeks (range, 3-75 weeks). Follow-up included sonography, excretory urography, and determination of serum levels of creatinine in all cases and furosemide scintigraphy and the Whitaker test in selected cases. Implantation of the Wallstent device was successful in 30 (97%) of 31 cases attempted. The survival rate was 81% after 6 months and 61% after 8 months. The primary patency was 83% after 30 weeks. Complications were macrohematuria (one patient) and incrustation (two patients). No infection and no migration or compression of the stent were observed. Implantation of a Wallstent device is a safe and effective alternative to double-J catheter placement in tumor-associated ureteral obstruction.