Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

Springer Science and Business Media LLC - Tập 21 Số 1 - 2021
Wei Wang1, Xiaoshuai Gao1, Jixiang Chen1, Zhenghuan Liu1, Peng Liao1, Xin Wei1
1Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People’s Republic of China

Tóm tắt

Abstract Background To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy. Methods We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee. Results The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up. Conclusions The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

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Tài liệu tham khảo

Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N’Dow J. Ureteric injury: a challenging condition to diagnose and manage. Nat Rev Urol. 2013;10(2):108–15.

De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, Torricelli FC, Di Palma C, Molina WR, Monga M, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015;67(1):125–37.

Fernández-Cacho LM, Ayesa-Arriola R. Quality of life, pain and anxiety in patients with nephrostomy tubes. Rev Lat Am Enfermagem. 2019;27:e3191.

Lange D, Bidnur S, Hoag N, Chew BH. Ureteral stent-associated complications–where we are and where we are going. Nat Rev Urol. 2015;12(1):17–25.

Chung SY, Stein RJ, Landsittel D, Davies BJ, Cuellar DC, Hrebinko RL, Tarin T, Averch TD. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol. 2004;172(2):592–5.

Moskovitz B, Halachmi S, Nativ O. A new self-expanding, large-caliber ureteral stent: results of a multicenter experience. J Endourol. 2012;26(11):1523–7.

World Medical Association Declaration of Helsinki. ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.

Gao X, Chen J, Wang W, Peng L, Di X, Xiao K, Li H, Wei X. Step-by-step technique for the endoscopic treatment of ureteric stricture. BJU Int 2021

Leung VY, Rasalkar DD, Liu JX, Sreedhar B, Yeung CK, Chu WC. Dynamic ultrasound study on urinary bladder in infants with antenatally detected fetal hydronephrosis. Pediatr Res. 2010;67(4):440–3.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

Delacroix SE Jr, Winters JC. Urinary tract injures: recognition and management. Clin Colon Rectal Surg. 2010;23(2):104–12.

Cichoń W, Maciukiewicz P. Iatrogenic ureteral injury in adults–diagnosis and treatment. Przegl Lek. 2014;71(12):700–2.

Vorobev V, Beloborodov V, Golub I, Frolov A, Kelchevskaya E, Tsoktoev D, Maksikova T. Urinary system iatrogenic injuries: problem review. Urol Int. 2021;105:460–9.

Lobo N, Kulkarni M, Hughes S, Nair R, Khan MS, Thurairaja R. Urologic complications following pelvic radiotherapy. Urology. 2018;122:1–9.

Zhong Q, Song T, Zeng J, Lin T, Fan Y, Wei X. Initial experiment of self-expanding metal ureteral stent in recurrent ureteral stenosis after kidney transplantation. Am J Transplant. 2020;21:1983–4.

Dong WM, Wang MR, Hu H, Wang Q, Xu KX, Xu T. [Initial clinical experience and follow-up outcomes of treatment for ureteroileal anastomotic stricture with Allium coated metal ureteral stent]. Beijing Da Xue Xue Bao Yi Xue Ban. 2020;52(4):637–41.

Baumgarten AS, Hakky TS, Carrion RE, Lockhart JL, Spiess PE. A single-institution experience with metallic ureteral stents: a cost-effective method of managing deficiencies in ureteral drainage. Int Braz J Urol. 2014;40(2):225–31.

Taylor ER, Benson AD, Schwartz BF. Cost analysis of metallic ureteral stents with 12 months of follow-up. J Endourol. 2012;26(7):917–21.

Papatsoris AG, Buchholz N. A novel thermo-expandable ureteral metal stent for the minimally invasive management of ureteral strictures. J Endourol. 2010;24(3):487–91.

Ganatra AM, Loughlin KR. The management of malignant ureteral obstruction treated with ureteral stents. J Urol. 2005;174(6):2125–8.

Rosenberg BH, Bianco FJ Jr, Wood DP Jr, Triest JA. Stent-change therapy in advanced malignancies with ureteral obstruction. J Endourol. 2005;19(1):63–7.

Nagele U, Kuczyk MA, Horstmann M, Hennenlotter J, Sievert KD, Schilling D, Walcher U, Stenzl A, Anastasiadis AG. Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis. World J Urol. 2008;26(3):257–62.

Wah TM, Irving HC, Cartledge J. Initial experience with the resonance metallic stent for antegrade ureteric stenting. Cardiovasc Intervent Radiol. 2007;30(4):705–10.

Wang HJ, Lee TY, Luo HL, Chen CH, Shen YC, Chuang YC, Chiang PH. Application of resonance metallic stents for ureteral obstruction. BJU Int. 2011;108(3):428–32.

Gayed BA, Mally AD, Riley J, Ost MC. Resonance metallic stents do not effectively relieve extrinsic ureteral compression in pediatric patients. J Endourol. 2013;27(2):154–7.

Agrawal S, Brown CT, Bellamy EA, Kulkarni R. The thermo-expandable metallic ureteric stent: an 11-year follow-up. BJU Int. 2009;103(3):372–6.

Maan Z, Patel D, Moraitis K, El-Husseiny T, Papatsoris AG, Buchholz NP, Masood J. Comparison of stent-related symptoms between conventional Double-J stents and a new-generation thermoexpandable segmental metallic stent: a validated-questionnaire-based study. J Endourol. 2010;24(4):589–93.

Liu JS, Hrebinko RL. The use of 2 ipsilateral ureteral stents for relief of ureteral obstruction from extrinsic compression. J Urol. 1998;159(1):179–81.

Vogt B, Blanchet LH. 10-year experience with reinforced ureteral stents for malignant ureteral obstruction. Res Rep Urol. 2021;13:581–9.

Elsamra SE, Motato H, Moreira DM, Waingankar N, Friedlander JI, Weiss G, Smith AD, Okeke Z. Tandem ureteral stents for the decompression of malignant and benign obstructive uropathy. J Endourol. 2013;27(10):1297–302.

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Tập 21 Số 1

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