1173 OUTCOMES OF METALLIC RESONANCE® STENTS IN MALIGNANT URETERAL OBSTRUCTION (2012)

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121173 OUTCOMES OF METALLIC RESONANCE® STENTS IN MALIGNANT URETERAL OBSTRUCTION Zachariah Goldsmith, Agnes Wang, Michael Lipkin, Lionel Banez, Muhammad Iqbal, Gastón Astroza, Michael Ferrandino, Brant Inman, and Glenn Preminger Zachariah GoldsmithZachariah Goldsmith Durham, NC More articles by this author , Agnes WangAgnes Wang Durham, NC More articles by this author , Michael LipkinMichael Lipkin Durham, NC More articles by this author , Lionel BanezLionel Banez Durham, NC More articles by this author , Muhammad IqbalMuhammad Iqbal Durham, NC More articles by this author , Gastón AstrozaGastón Astroza Durham, NC More articles by this author , Michael FerrandinoMichael Ferrandino Durham, NC More articles by this author , Brant InmanBrant Inman Durham, NC More articles by this author , and Glenn PremingerGlenn Preminger Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Malignant ureteral obstruction (MUO) often necessitates chronic indwelling ureteral stents. The indwell time of a metallic ureteral stent has been suggested for up to 12 months, yet its clinical outcomes in MUO have not been completely defined. We sought to evaluate the outcomes of metallic ureteral stents placed for MUO, and to identify clinical predictors of failure or success. METHODS All patients undergoing placement of the metallic Resonance® stent (Cook Medical) for MUO at Duke University were identified retrospectively. Patient demographics, oncologic variables, and clinical outcomes were examined. Stent failure was defined as unplanned stent exchange or nephrostomy tube placement for signs or symptoms of recurrent ureteral obstruction (recurrent hydronephrosis or increasing creatinine) or stent migration. Predictors of time to stent failure were assessed using Cox regression. RESULTS A total of 37 stents were placed in 25 patients with MUO beginning in September 2010. Mean age was 65 years. Mean follow-up was 13.1 weeks. Twelve stents (32%, 12/37) were identified to fail. Progressive hydronephrosis (58%, 7/12) and increasing creatinine (50%, 6/12) were the most common signs of stent failure (not mutually-exclusive), followed by flank pain (25%, 3/12). Three failed stents (25%, 3/12) had migrated distally. No stents required removal for recurrent infection. The majority of stent failures (83%, 10/12) were identified during routine oncologic surveillance. Stent failure was managed by replacement with a new metallic stent (50%, 6/12), placing an alternative ureteral stent (17%, 2/12), nephrostomy tube (17%, 2/12), or observation (17%, 2/12). Cystoscopic evidence of malignant bladder invasion at the time of stent placement was associated with a significantly increased risk of failure (HR: 6.50, 95% CI: 1.45 – 29.20, P=0.015). Notably, symptomatic subcapsular hematomas were observed in three patients following metallic stent placement. Each of these cases was managed conservatively, but required an average of 4 imaging tests per patient with an estimated cost of $21,688. CONCLUSIONS This is the largest series of MUO patients managed with the metallic Resonance® stent. Patients with a bladder tumor at the time of stent placement are at significantly higher risk for stent failure. Patients should be counseled on the risk of hematoma formation with this stent. With a 32% failure rate in this short-term series, long term follow-up is needed to determine the utility of this device for MUO. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e475 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachariah Goldsmith Durham, NC More articles by this author Agnes Wang Durham, NC More articles by this author Michael Lipkin Durham, NC More articles by this author Lionel Banez Durham, NC More articles by this author Muhammad Iqbal Durham, NC More articles by this author Gastón Astroza Durham, NC More articles by this author Michael Ferrandino Durham, NC More articles by this author Brant Inman Durham, NC More articles by this author Glenn Preminger Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...