Category: Endoscopic

MP21-18 - Long-term outcomes of metallic ureteral stents for intractable benign ureteral strictures and predictive factors that affect ureteral patency.

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : We investigated the long-term follow-up outcomes of ureteral metallic stents for intractable benign ureteral strictures. The predictive factors that affect stent patency were also evaluated.


Methods :

 A total of 46 ureter units were included from May 2010 to December 2017, retrospectively. Chronic ureteral strictures caused by radiation therapy, retroperitoneal fibrosis, pelvic surgery and variety of benign causes were included. Obstructions caused by direct malignant invasion were excluded. The metallic ureteral stent includes covered mesh stent (Uventa) and thermo-expandable stent (Memokath). Primary success was defined as the maintenance of stent patency without any additional procedures. And Overall success was defined as maintenance of stent patency with salvage procedures.


Results :

Covered mesh stents were placed in 25 ureter units and thermo-expandable stents were in 21 units. All stents were initially placed without problem. The mean follow-up months was 41.4±23.1 in mesh stent and 34.4±16.5 months in thermo-expandable stent (p=0.250). Primary success was obtained 54.9% in mesh stent and 70.4% in thermo-expandable stent (p=0.204) at 1st year of stent insertion. Overall success was 78.7% and 75.4% in both group at 1st year (p=0.586). Hyperplasia was the main reason for the failure of mesh stent (20.0~56.0%), and encrustation was the main reason for the failure of thermo-expandable stent (14.3~42.9%). Non-pelvic ureter (upper ureteral stricture only) showed worse results than pelvic ureter in overall success (Hazard ratio [HR])=4.203, p=0.030). Longer stent was found to have a good effect on primary and overall success (HR=0.185, p=0.047 and HR=0.111, p=0.018). Prior radiation therapy was a factor that adversely affects the overall success (HR=5.412, p=0.048). And previous PCN status showed negative results both in primary (HR=4.014, p=0.003) and overall success (HR=3.064, p=0.035).


Conclusions : The treatment outcomes of mesh stent and thermo-expandable stent were comparable in chronic benign ureteral strictures, especially at 1st year of stent insertion. Non-pelvic ureteral stricture, prior radiation therapy, previous PCN had negative effect on success. The longer stent placement had positive effect on stent success of patency.

Joong Won Choi

Fellowship
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

My name is Joong Won Choi, and I am a urologist. I graduated from Chung-Ang university in Seoul, South Korea and have a master's degree. I belong to the Korea Institute of Endourology. Currently, I am doing fellow under professor Duk Hyun Han, an Endourologist at Samsung Medical Center, and I'm studying for my Ph.D.

Jae Dong Chung


Seoul, Seoul-t'ukpyolsi, Republic of Korea

Kyung Jin Chung

Associate Professor
Department of Urology, Gachon University Gil Hospital
Incheon, Inch'on-jikhalsi, Republic of Korea

Seol Ho Choo

assistant professor
Ajou University School of Medicine
Suwon, Kyonggi-do, Republic of Korea

Kwang Ho Ryu

Physician
Gwangmyeong Sungae Hospital
Kwangmyung, Kyonggi-do, Republic of Korea

Deok Hyun Han

Associate professor
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Dr. Deok Hyun Han is an associate professor in the Department of Urology at Samsung Medical Center that is located in Seoul, South Korea. He earned his Medical Degree at the Seoul National University and completed the internship at the Seoul National University Hospital for one year. Then he moved to Samsung Medical Center to complete his urological residency and was certified by the Korean Board of Urology. During his fellowship at the Samsung Medical Center, he focused on advanced endourology and minimally invasive surgery.
He has performed many cases of therapeutic and diagnostic flexible ureteroscopies and percutaneous nephrolithotomies with his own primary access. He also has performed various kinds of laparoscopic surgeries including conventional, single-port, and robot-assisted laparoscopy. He is interested in novel devices and techniques in the field of minimally invasive surgery. He has been a board member of the Korean Endourological Society since 2010 and is the current General Secretary in this society.

Contact information: dhhan@skku.edu