Abu Dhabi, United Arab Emirates (UroToday.com) In this session, Dr. Ramakrishna Venkatesh described their experience with malignant ureteral obstruction management, and analysis of clinical factors associated with stent-related issues at Washington University in St. Louis. Ureteral stenting provides symptomatic relief in patients with malignant ureteral obstruction. However, this is a clinical challenge because it often involves frequent stent exchanges because of stent failure.
Their study is a large series of 78 patients treated with indwelling ureteral stents for malignant ureteral obstruction. They aimed to identify variables that would predict stent failure or a complication with the stent. The need for unplanned stent exchange or removal, placement of a percutaneous nephrostomy tube or tandem stents were considered stent failure. With these criteria, 35 of the patients had stent failure, with 22 needing unplanned stent exchanges, 23 requiring percutaneous nephrostomy, and 6 requiring tandem stents.
No factors were identified to be predictive of stent failure. The different stent materials did not change the rate of stent failure. The median survival time in these patients after stent placement was 19.9 months. UTI developed more frequently in patients who underwent bilateral stenting and patients who had a history of radiation.
This is a difficult dilemma, as the stent is placed for symptomatic relief, but can end up being burdensome for the patient. Stent failure would require more exchanges, which therefore decreases quality of life. These patients would benefit from better methods to minimize stent-related issues. The urologist may need to think in terms of palliative care in this situation. If a patient is not symptomatic but hydronephrotic and can still undergo chemotherapy, offering to wait for stent placement may be an option.
Presented by: Ramakrishna Venkatesh, MD, Urologist, Washington University School of Medicine, St. Louis, Missouri, USA
Written by: Rajiv Karani (Department of Urology, University of California, Irvine) Medical Writer for UroToday.com at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates