Endoscopic

Moderated Poster Session

MP21-7 - Ureteral stent failures and complications in patients with malignant ureteral obstruction

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 243

Introduction & Objective : Ureteral stenting is performed to treat renal obstruction or for symptomatic relief in patients with malignant ureteral obstruction (MUO). However, the management of MUO remains a clinical challenge, requiring frequent stent exchanges due to stent failure or other urological complications. We report our experience with MUO management and analysis of clinical factors associated with stent-related issues.


Methods : We retrospectively reviewed records of patients treated with indwelling ureteral stents for MUO in non-urothelial malignancies at our tertiary care institution between 2008 and 2017 (Table 1). Multivariate logistic regression was performed to identify clinical variables predictive of stent failure or complications. Stent failure was defined as need for unplanned stent exchange or removal, placement of percutaneous nephrostomy (PCN), or tandem stents.


Results : In our cohort of 65 patients, the median (range) number of stent exchanges was 3 (0-17) and total stent dwell time was 14.9 (0.1-82.8) months. Thirty-five patients (53.8%) developed a urinary tract infection (UTI). Twenty-nine patients (44.6%) had stent failure. Of these, 20 patients (30.8%) underwent unplanned stent exchanges, while 11 (16.9%) required PCN following initial stent placement, and 6 (9.2%) required tandem stents. Nine (31.0%) patients with stent failure were treated with upsized stents, leading to resolution of failure in 6 patients. In patients with ≥2 exchanges (N=40), mean time between stent exchanges was 4.4 ± 2.1 months. Bilateral stenting (OR 2.36, p=0.041) predicted UTI development (Table 2). Median overall patient survival after initial stent placement was 17.9 months (95% CI 15.4-32.0).


Conclusions :

Ureteral stent failure and complications commonly occur in patients with MUO. Better methods to minimize stent-related issues and to optimize renal drainage are needed.

Nicholas A. Pickersgill

Medical Student
Washington University School of Medicine in St. Louis

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    Kefu Du

    Fellow
    Washington University in St. Louis

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      Robert Figenshau

      Professor
      Washington University in St. Louis

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        Alana Desai

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          Joel Vetter

          Statistician
          Washington University in St. Louis

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            Ramakrishna Venkatesh

            Professor
            Washington University in St. Louis

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