Ureteral stenting in patients with bladder cancer may become necessary in order to protect the ureteral orifice during transurethral resection of the tumor or for relief of upper urinary tract (UUT) obstruction. However, it is believed to increase metachronous upper tract urothelial carcinoma (UTUC) risk.
We performed a systematic review and meta-analysis of studies comparing ureteral stenting versus nephrostomy or no drainage with regard to the risk of metachronous UTUC. Records were identified through databases searches and sources of grey literature up to October 2020 (PROSPERO: CRD42020178298).
Five studies (3309 individuals) were included. Overall, 278 ureteral stents were placed and 20 (7.2%) patients developed metachronous UTUC, while 131 patients were treated with nephrostomy and 3 (2.3%) cases of metachronous UTUC occurred. Patients treated with ureteral stents had a higher likelihood of metachronous UTUC compared to no stents (OR: 3.49, 95%CI: 1.43-8.48, I2=52%) and no UUT drainage (OR: 3.37, 95%CI: 1.49-7.63, I2=45%). No difference with regard to metachronous UTUC was observed between stent and nephrostomy (OR: 3.07, 95%CI: 0.41-22.98, I2=54%). For the same outcomes, no difference was noted for patients with hydronephrosis. The level of evidence for all measures was evaluated as low.
Stenting as a preventive measure after resection of tumors involving the orifice should be avoided, when possible, as it increases the risk of metachronous UTUC. In cases of hydronephrosis, drainage with either nephrostomy or stent is recommended depending on individual patient cases as both interventions do not differ regarding metachronous UTUC risk.
The Journal of urology. 2020 Dec 07 [Epub ahead of print]
Petros Sountoulides, Nikolaos Pyrgidis, Sabine Brookman-May, Ioannis Mykoniatis, Theofilos Karasavvidis, Dimitrios Hatzichristou
Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece., Ludwig Maximilians University (LMU) Munich, Munich, Germany., Aristotle University of Thessaloniki, Thessaloniki, Greece.