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Dosanjh A, Coupland B, Mytton J, King DS, Mintz H, Lock A, Nanton V, Mariappan P, Trudgill N, Patel P. High early mortality following percutaneous nephrostomy in metastatic cancer: a national analysis of outcomes. BMJ Support Palliat Care 2024:spcare-2024-004937. [PMID: 39002950 DOI: 10.1136/spcare-2024-004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/21/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES To assess the outcomes of percutaneous nephrostomy in England for renal decompression, in the context of metastatic cancer. METHODS Retrospective observational study of all patients undergoing nephrostomy with a diagnosis of metastatic cancer from 2010 to 2019 in England, identified and followed up within Hospital Episode Statistics.The primary outcome measure was mortality (14-day and 30-day postprocedure). Secondary outcomes included subsequent chemotherapy or surgery and direct complications of nephrostomy. RESULTS 10 932 patients were identified: 58.0% were male, 51.0% were >70 years old and 57.7% had no relevant comorbidities (according to Charlson's criteria, other than cancer).1 in 15 patients died within 14 days of nephrostomy and 1 in 6 died within 30 days. Factors associated with higher 30-day mortality were the presence of comorbidities (Charlson score 1-4 (OR 1.27, 95% CI 1.08 to 1.50, p=0.003), score 5+ (OR 1.29, 95% CI 1.14 to 1.45), p<0.001)); inpatient nephrostomy (OR 3.76, 95% CI 2.75 to 5.14, p<0.001) and admitted under the care of specialities of internal medicine (OR 2.10, 95% CI 1.84 to 2.40, p<0.001), oncology (OR 1.80, 95% CI 1.51 to 2.15, p<0.001), gynaecology/gynaeoncology (OR 1.66, 95% CI 1.21 to 2.28, p=0.002) or general surgery (OR 1.62, 95% CI 1.32 to 1.98, p<0.001)), compared with urology.25.4% received subsequent chemotherapy. Receiving chemotherapy was associated with younger patients (eg, age 18-29 (OR 4.04, 95% CI 2.66 to 6.12, p<0.001) and age 30-39 (OR 3.07, 95% CI 2.37 to 3.97, p<0.001)) and under the care of oncology (OR 1.60, 95% CI 1.40 to 1.83, p<0.001) or gynaecology/gynaeoncology (OR 1.64, 95%CI 1.28 to 2.10, p<0.001) compared with urology.43.8% had subsequent abdominopelvic surgery. Not receiving surgery was associated with inpatient nephrostomy (OR 0.82, 95%CI 0.72 to 0.95,p=0.007): non-genitourinary cancers (eg, gynaecology/gynaeoncology cancer (OR 0.86, 95% CI 0.74 to 0.99, p=0.037)); and under the care of a non-surgical specialty (medicine (OR 0.69, 95% CI 0.63 to 0.77, p<0.001), oncology (OR 0.58, 95% CI 0.51 to 0.66, p<0.001)).24.5% of patients had at least one direct complication of nephrostomy: 12.5% required early exchange of nephrostomy, 8.1% had bleeding and 6.7% had pyelonephritis. CONCLUSIONS The decision to undertake nephrostomy in patients with poor prognosis cancer is complex and should be undertaken in a multidisciplinary team setting. Complication rates are high and minimal survival benefit is derived in many patients, especially in the context of emergency inpatient care.
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Affiliation(s)
- Amandeep Dosanjh
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Benjamin Coupland
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jemma Mytton
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic Stephen King
- Department of Gastroenterology, The Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
| | - Harriet Mintz
- School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Lock
- Department of Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Veronica Nanton
- Department of Social Sciences and Systems in Health, University of Warwick, Coventry, UK
| | - Param Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Nigel Trudgill
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Prashant Patel
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Artiles Medina A, Laso García I, González Tello F, Álvarez Rodríguez S, Hevia Palacios M, Mata Alcaraz M, Mínguez Ojeda C, Arias Funez F, Gómez Dos Santos V, Burgos Revilla FJ. The challenging management of malignant ureteral obstruction: Analysis of a series of 188 cases. Curr Urol 2024; 18:34-42. [PMID: 38505156 PMCID: PMC10946639 DOI: 10.1097/cu9.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/09/2022] [Indexed: 03/08/2023] Open
Abstract
Background Malignant ureteral obstruction (MUO) is a common condition that complicates the course of advanced malignancies. The aims of this study are to analyze the causes, management, and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors. Furthermore, we studied the complications and outcomes in patients who underwent urinary diversion. Materials and methods A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November 2020. Demographic, clinical, radiological, laboratory, and management data were collected. Survival curves were estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival. Results A total of 188 patients were included. The mean age was 69.01 years (SD, 14.95 years), and the majority (54.8%) were male. The most common mechanism leading to MUO was compression by a pelvic mass (36.9%), and the 3 most frequent tumors causing MUO were prostate (17.6%), bladder (16.5%), and rectal cancer (11.7%).Forty-seven patients (25%) underwent urinary diversion: 23 (48.9%) underwent double-J stenting and 21 (44.7%) underwent percutaneous nephrostomy. The most common reason for urinary diversion was acute kidney injury (53.3%). Recovery of renal function was observed in 55.8% of the patients after urinary diversion. The most frequently identified complications after urinary diversion were urinary tract infection (24.4%), hematuria (17.0%), and urinary sepsis (14.9%). The median survival after hydronephrosis diagnosis was 6.43 months (interquartile range, 1.91-14.81 months). In patients who underwent urinary decompression, the median survival after urinary diversion was 8.67 months (interquartile range, 2.99-17.28 months). In the multivariate analysis, a lower grade of hydronephrosis and cancer cachexia negatively impacted survival. Conclusions Cancer patients with MUO have a poor prognosis; therefore, the risk-benefit ratio of urinary diversion should be carefully considered. Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion.
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Affiliation(s)
| | - Inés Laso García
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Heo JE, Jeon DY, Lee J, Han HH, Jang WS. Prediction of Stent Failure for Malignant Ureteral Obstruction in Non-Urological Cancer. Yonsei Med J 2023; 64:665-669. [PMID: 37880847 PMCID: PMC10613761 DOI: 10.3349/ymj.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE To analyze prognostic factors associated with ureteral stent failure and to develop a prediction model for malignant ureteral obstruction (MUO) in patients with non-urological cancers. MATERIALS AND METHODS We retrospectively reviewed patients with non-urological cancers who underwent ureteral stenting or percutaneous nephrostomy (PCN) for MUO between 2006 and 2014. Variables predicting stent failure were identified using Cox regression analysis. RESULTS Of the 743 patients, 468 (63.0%) underwent ureteral stenting only, and 275 (37.0%) underwent PCN owing to technical (n=215) or functional (n=60) stent failure. The median overall survival was 4 [interquartile range (IQR) 1-11] months, and the median interval duration to stent failure was 2 (IQR 0-7) months. In univariate analysis, lower gastrointestinal cancer, previous radiotherapy to the pelvis, bladder invasion, lower ureteral obstruction, and low previous estimated glomerular filtration rate (eGFR) (<30 mL/min/1.73 m²) were significantly associated with a decreased survival rate. In multivariate analysis, bladder invasion and previous eGFR were significant predictors. With these two predictors, we divided patients into three groups based on their presence: low-risk (neither factor; n=516), intermediate-risk (one factor; n=206), and high-risk (both factors; n=21). The median stent failure-free survival rates of patients in the low-, intermediate-, and high-risk groups were 26 (8-unreached), 1 (0-18), and 0 (0-0) months, respectively (p<0.001). CONCLUSION In cases of ureteral obstruction caused by non-urological cancers, patients with bladder invasion and a low eGFR showed poor stent failure-free survival. Therefore, PCN should be considered the primary procedure for these patients.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Young Jeon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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4
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Osinibi E, Doan H, Mercado-Campero A, Abbaraju J, Masood S, Madaan S. The implications when offering percutaneous nephrostomy for the management of malignant obstructive uropathy secondary to urological malignancy: can we be more selective? Ther Adv Urol 2023; 15:17562872231207729. [PMID: 37901283 PMCID: PMC10612453 DOI: 10.1177/17562872231207729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background & Objectives Percutaneous nephrostomy (PN) for malignant ureteric obstruction (MUO) is increasingly accessible with high success rates. However, it is not without associated risks and morbidity, impacting quality of life, while not improving overall survival. In two UK hospitals, we investigated the outcomes of undergoing PN for MUO, to inform future patient counselling and selection for this intervention. Methods A retrospective audit of electronic records identified patients that received PN for bladder, and prostate cancer (PCa) between January 2015 and December 2018. Hospital 1 had a 24-h nephrostomy service, while Hospital 2 had a limited service; Group A: recurrent or treatment-resistant PCa, Group B: primary PCa, Group C: Bladder cancer. Results A total of 261 patients (Hospital 1 = 186, Hospital 2 = 75), had PN insertion. Seventy-eight had prostate or bladder cancer. Group A n = 30, Group B n = 12, Group C n = 36. Median age = 79 [interquartile range (IQR) = 72-86]. Following PN insertion, 12-month mortality was significantly greater in Hospital 1 at 82%, versus 52% in Hospital 2 (p = 0.015). Median survival: Group A: 177 days (IQR = 80-266), Group B: 209 days (IQR = 77-352), Group C: 145 days (IQR = 97-362). There was no significant difference in same-admission mortality, although group A had the greatest same-admission mortality at 17%. A total of 69% of all patients received bilateral nephrostomies. Patients with bilateral versus unilateral PN had no difference in mortality or nadir creatinine. Conclusion Most patients with malignant obstruction secondary to prostate or bladder cancer lived less than 12 months after PN insertion. When offering PN, careful consideration of disease prognosis should be made, and frank discussion of the implications of a life-long nephrostomy with patients and relatives.
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Affiliation(s)
- Elizabeth Osinibi
- Darent Valley Hospital Medway Maritime Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK
| | - Hong Doan
- Medway Maritime Hospital, Gillingham, UK
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Li C, Liu M, Li J, Zhao X, Wang Y, Chen X, Wang W, Sun S, Feng C, Cai Y, Wu F, Du C, Zhang Y, Zhang S, Qu J. Relationship between metastasis and second primary cancers in women with breast cancer. Front Oncol 2022; 12:942320. [PMID: 36248962 PMCID: PMC9556865 DOI: 10.3389/fonc.2022.942320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Breast cancer (BC) survivors have an increased risk of developing second primary cancers (SPCs); however, it is still unclear if metastasis is a risk factor for developing SPCs. Usually, long-term cancer survivors face an increased risk of developing SPCs; however, less attention has been paid to SPCs in patients with metastatic cancer as the survival outcomes of the patients are greatly reduced. Methods A total of 17,077 American women diagnosed with breast cancer between 2010 and 2018 were identified from Surveillance, Epidemiology, and End Results (SEER) database and were included in the study. The clinical characteristics, standardized incidence ratio (SIR), standardized mortality ratio (SMR), and patterns of SPCs in BC patients with no metastasis, regional lymph node metastasis, and distant metastasis were investigated. Kaplan-Meier method was used to compare the prognosis of BC patients after developing SPCs with different metastatic status. XGBoost, a high-precision machine learning algorithm, was used to create a prediction model to estimate the prognosis of metastatic breast cancer (MBC) patients with SPCs. Results The results reveal that the SIR (1.01; 95% CI, 0.99–1.03, p>0.05) of SPCs in non-metastasis breast cancer (NMBC) patients was similar to the general population. Further, patients with regional lymph node metastasis showed an 8% increased risk of SPCs (SIR=1.08, 95%CI, 1.05–1.11, p<0.05), and patients with distant metastasis had a 26% increased risk of SPCs (SIR=1.26, 95%CI, 1.16–1.37, p<0.05). The SIR of SPCs in all patients below the age of 40 was the highest, which decreased with age. Patients with poorly differentiated cancers, large tumor size, and late N stage had an increased risk of SPCs. However, an increase in SIR of SPCs was observed in distant MBC patients, even at the early T1 (SIR=1.60, 95% CI, 1.22–1.98, p<0.05) and N1 (SIR=1.27, 95% CI, 1.10–1.44, p<0.05) stage. An increase in the SIR of SPCs was observed in patients with triple-negative BC, and the SIR of SPC increased with metastasis development in BC patients with luminal A subtype. The peak of SPCs risk occurrence was earlier in MBC patients (4-6 months and 10 months) compared to NMBC patients (12 months). The effect of metastasis on the prognosis of SPCs patients was dependent on the type of SPCs. Meanwhile, the XGBoost model was created to predict the 3-year (AUC=0.873) and 5-year survival (AUC=0.918) of SPCs in MBC patients. Conclusions Our study provides novel insight into the impact of metastasis on SPCs in BC patients. Metastasis could promote the second primary tumorigenesis which further increased cancer-related deaths. Therefore, more attention should be paid to the occurrence of SPCs in MBC patients.
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Affiliation(s)
- Chaofan Li
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Mengjie Liu
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jia Li
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xixi Zhao
- Department of Radiation Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yusheng Wang
- Department of Otolaryngology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xi Chen
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Weiwei Wang
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shiyu Sun
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Cong Feng
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yifan Cai
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Fei Wu
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chong Du
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yinbin Zhang
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shuqun Zhang
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Shuqun Zhang, ; Jingkun Qu,
| | - Jingkun Qu
- Department of Oncology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Shuqun Zhang, ; Jingkun Qu,
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6
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Nóbrega L, Zanon JR, Andrade CEEMDC, Schmidt RL, Dos Santos MH, Dos Reis R. Prognostic role of hydronephrosis in the treatment of patients with locally advanced cervical cancer: a retrospective cohort. Int J Gynecol Cancer 2022; 32:ijgc-2022-003679. [PMID: 35973739 PMCID: PMC9484387 DOI: 10.1136/ijgc-2022-003679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive uropathy is present in almost 50% of patients with advanced cervical cancer and is associated with worse outcomes. OBJECTIVE To estimate the prognostic role of hydronephrosis and the impact of ureteral obstruction resolution in patients with locally advanced cervical cancer undergoing treatment. METHODS A retrospective cohort study was conducted of patients with International Federation of Gynecology and Obstetrics 2018 stage IIIB to IVA treated in a tertiary oncologic referral center in Brazil between January 2009 and June 2018. Three different groups were evaluated: (I) without hydronephrosis, (II) with hydronephrosis and urinary diversion, and (III) with hydronephrosis but no urinary diversion. Kaplan-Meier curves and log-rank tests estimated overall survival and progression-free survival based on the presence of hydronephrosis and urinary diversion. Clinicopathological variables were evaluated using univariate and multivariate Cox proportional hazard regression model for overall survival and progression-free survival. RESULTS A total of 151 patients were evaluated: group I - 62 (41.1%); II - 44 (29.1%), and III - 45 (29.8%). Stage, histological type or grade, tumor size, parametrial or lymph node involvement were not statistically different between groups. Group I had more favorable overall survival than groups II (p<0.003) and III (p<0.02); however, no difference was noted between groups II and III. Progression-free survival was similar between groups (log-rank test p=0.95). Univariate analysis revealed hydronephrosis (p=0.002) and concurrent chemoradiotherapy (p<0.001) as a prognostic factor for worse overall survival; while tumor size (p=0.023), pelvic lymphadenopathy (p=0.015), and histological type (p=0.03) were associated with worse progression-free survival. On multivariate analysis, hydronephrosis remained as an independently associated factor with worse overall survival (HR=2.06; 95% CI 1.12 to 3.79, p=0.02). CONCLUSION Patients with locally advanced cervical cancer with hydronephrosis had lower overall survival even after controlling for potential confounding factors, but no difference in progression-free survival. Urinary diversion showed no impact on overall survival or progression-free survival.
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Affiliation(s)
- Leandro Nóbrega
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Jeferson Rodrigo Zanon
- Department of Palliative Care and Nephrology, Cancer Hospital of Jales - Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
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7
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Wu KJ, Chen YZ, Chen M, Chen YH. Clinical factors predicting ureteral stent failure in patients with external ureteral compression. Open Med (Wars) 2021; 16:1299-1305. [PMID: 34541328 PMCID: PMC8415538 DOI: 10.1515/med-2021-0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022] Open
Abstract
Double-J stent (DJ) placement is usually the treatment of choice for relieving external compression of the ureter. However, in some cases DJ function may become impaired and a percutaneous nephrostomy (PCN) may be required. Previous studies have reported different predictive factors for choosing PCN or DJ insertion as the initial treatment. In this study, we analyzed the risk factors for DJ failure in patients with external ureteral compression. Our results showed that the patients with moderate and severe hydronephrosis (p-value = 0.0171 and 0.0249, respectively), preexisting pyuria (p-value = 0.0128), or lower ureter obstruction (p-value = 0.0305) were more prone to DJ laterality. Age was also an important predictor. Urologists should pay more attention to these patients and consider PCN as the initial treatment.
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Affiliation(s)
- Kuan Ju Wu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi Zhong Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hsin Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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8
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Gunawan B, Foster K, Hardy J, Good P. Survival following palliative percutaneous nephrostomy tube insertion in patients with malignant ureteric obstruction: Validating a prognostic model. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1905145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ben Gunawan
- Palliative and Supportive Care, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, 4101, Qld, Australia
- Princess Alexandra Hospital, Woolloongabba, 4102, QLD, Australia
| | - Karyn Foster
- Palliative and Supportive Care, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, 4101, Qld, Australia
- Mater Research - University of Queensland, South Brisbane, Australia
| | - Janet Hardy
- Palliative and Supportive Care, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, 4101, Qld, Australia
- Mater Research - University of Queensland, South Brisbane, Australia
| | - Phillip Good
- Palliative and Supportive Care, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, 4101, Qld, Australia
- Mater Research - University of Queensland, South Brisbane, Australia
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9
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Izumi K, Shima T, Shigehara K, Sawada K, Naito R, Kato Y, Ofude M, Kano H, Iwamoto H, Yaegashi H, Nakashima K, Iijima M, Kawaguchi S, Nohara T, Kadono Y, Mizokami A. A novel risk classification score for malignant ureteral obstruction: a multicenter prospective validation study. Sci Rep 2021; 11:4455. [PMID: 33627826 PMCID: PMC7904864 DOI: 10.1038/s41598-021-84054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Emergence of malignant ureteral obstruction (MUO) has been reported as a sign of poor prognosis; however, the distribution of survival time in patients with MUO is considerably wide, and no risk classification score has been constructed. To evaluate whether a novel risk classification score for overall survival that we previously developed, is effective in a large cohort. Investigator-initiated, prospective, multicenter diagnostic/prognostic study was conducted. Patients with MUO were divided into three risk groups based on the score calculated using four prognostic factors (PLaCT: Primary site, Laterality, serum Creatinine level, and Treatment for primary site) at the first visit, and prospective follow-up was performed. Overall survival and ureteral stent failure-free survival of each risk group were compared. In total, 300 patients with 21 different primary sites were enrolled. The numbers of patients in good, intermediate, and poor risk groups were 105, 106, and 89, respectively. Median survival times of patients in good, intermediate, and poor risk groups were 406, 221, and 77 days, respectively (P < 0.0001). In 217 patients with ureteral stenting, median ureteral stent failure-free survival times of good, intermediate, and poor risk groups were 385, 183, and 57 days, respectively (P < 0.0001). Limitations include the limited ethnicity and the extended duration of study enrollment. The novel PLaCT risk classification score could divide MUO patients into three risk groups with distinct survival times and ureteral stent patencies. This score will aid in establishing prognosis and treatment strategy for all physicians engaged in cancer treatment.
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Affiliation(s)
- Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kiyoshi Sawada
- Department of Urology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Komatsu Municipal Hospital, Komatsu, Japan
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Fukui-Ken Saiseikai Hospital, Fukui, Japan
| | - Mitsuo Ofude
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.,Department of Urology, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Hiroshi Kano
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kazufumi Nakashima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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10
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Heo JE, Jeon DY, Lee J, Ham WS, Choi YD, Jang WS. Clinical Outcomes After Urinary Diversion for Malignant Ureteral Obstruction Secondary to Non-urologic Cancer: An Analysis of 778 Cases. Ann Surg Oncol 2021; 28:2367-2373. [PMID: 33389298 DOI: 10.1245/s10434-020-09423-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated patient outcomes after urinary diversion in order to manage malignant ureteral obstruction caused by non-urologic cancers and to evaluate predictive factors for overall survival. METHODS The study retrospectively reviewed patients with non-urologic malignancies who underwent ureteral stenting or percutaneous nephrostomy for ureteral obstruction between 2006 and 2014. The variables for predicting overall survival were identified by Cox regression analysis. RESULTS The study enrolled 778 patients, including 522 patients who underwent ureteral stenting and 256 patients who underwent percutaneous nephrostomy. Renal function was assessed immediately and then 2 weeks after urinary diversion. The median survival period was 5 months (interquartile range [IQR] 2-12 months). A total of 708 patients died. The patients who received chemotherapy after urinary diversion had a survival gain of 7 months compared with the patients who did not receive subsequent chemotherapy (p < 0.001). The survival rate did not differ between the various types of urinary diversion (p = 0.451). In the multivariate analysis, lower survival rates were significantly associated with male sex; previous chemotherapy without radiotherapy; an increasing number of events related to malignant dissemination; low preoperative hemoglobin (< 10 mg/dL), albumin (< 3 g/dL), and estimated glomerular filtration (< 60 mL/min/1.73 m2) rates; and no subsequent chemotherapy or radiotherapy. CONCLUSIONS In cases of ureteral obstruction caused by non-urologic malignancies, the overall survival was poor. However, the patients who received chemotherapy after urinary diversion had a survival gain of 7 months. Therefore, urinary diversion could be considered to preserve renal function for subsequent chemotherapy, whereas patients with the poor prognostic factors should be presented with the option of no intervention.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Young Jeon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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11
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Acute Kidney Injury Caused by Obstructive Nephropathy. Int J Nephrol 2020; 2020:8846622. [PMID: 33312728 PMCID: PMC7719507 DOI: 10.1155/2020/8846622] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
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12
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Haas CR, Shah O, Hyams ES. Temporal Trends and Practice Patterns for Inpatient Management of Malignant Extrinsic Ureteral Obstruction in the United States. J Endourol 2020; 34:828-835. [DOI: 10.1089/end.2020.0053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Christopher R. Haas
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Elias S. Hyams
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
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13
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Laso-García IM, Lorca-Álvaro J, Arias-Fúnez F, Díaz-Pérez D, Santiago-González M, Duque-Ruiz G, Burgos-Revilla FJ. Long-term results of the treatment of complex ureteral stenosis with extra-anatomic ureteral bypasses. Cent European J Urol 2020; 73:213-219. [PMID: 32782842 PMCID: PMC7407785 DOI: 10.5173/ceju.2020.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Complex ureteral obstruction is a pathology that has always been a challenge for the urologist, especially in patients with high surgical risk or with a short life expectancy. Material and methods Between 2002 and 2017, 13 extra-anatomical bypasses were placed. A descriptive retrospective study was carried out. An analysis of the permeability time of the prosthesis was performed using Kaplan-Meyer curves. Demographic and etiological characteristics as well as early and late complications were analysed. Results Etiologies were benign in 39% (including 3 transplant recipients) and malignant in 69%. Permeability rates were 90.9% at each of 12, 24 and 48 months, respectively, and 75.8% at 60 months. There were no deaths in the early postoperative period, nor intraoperative complications. The most frequent complications were infections. Three of them were associated with bypass extrusion, which needed to be removed. A total of 5 prosthesis had to be removed. 40% of the patients did not present complications. Conclusions The extra-anatomical ureteral bypass is an alternative to permanent nephrostomy in the treatment of complex ureteral strictures. Their patency rates after long-term follow-up vary from 90% to 75% at 48 and 60 months, respectively. Their complication rates can be considered acceptable in the patients’ clinical contexts.
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Affiliation(s)
- Inés M Laso-García
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Javier Lorca-Álvaro
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Fernando Arias-Fúnez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - David Díaz-Pérez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Marta Santiago-González
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Gemma Duque-Ruiz
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
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14
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Scheidt MJ, Hohenwalter EJ, Pinchot JW, Ahmed O, Bjurlin MA, Braun AR, Kim CY, Knavel Koepsel EM, Schramm K, Sella DM, Weiss CR, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Urinary Tract Obstruction. J Am Coll Radiol 2020; 17:S281-S292. [PMID: 32370972 DOI: 10.1016/j.jacr.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
Acute obstructive uropathy is a medical emergency, which often is accompanied by acute renal failure or sepsis. Treatment options to resolve the acute obstructive process include conservative medical management, retrograde ureteral stenting, or placement of percutaneous nephrostomy or nephroureteral catheters. It is important to understand the various treatment options in differing clinical scenarios in order to guide appropriate consultation. Prompt attention to the underlying obstructive process is often imperative to avoid further deterioration of the patient's clinical status. A summary of the data and most up-to-date clinical trials regarding treatment options for urinary tract obstruction is outlined in this publication. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric J Hohenwalter
- Panel Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Pinchot
- Panel Vice-Chair, University of Wisconsin, Madison, Wisconsin
| | | | - Marc A Bjurlin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; American Urological Association
| | - Aaron R Braun
- St. Elizabeth Regional Medical Center, Lincoln, Nebraska
| | - Charles Y Kim
- Duke University Medical Center, Durham, North Carolina
| | | | - Kristofer Schramm
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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15
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Folkard SS, Banerjee S, Menzies-Wilson R, Reason J, Psallidas E, Clissold E, Al-Mushatat A, Chaudhri S, Green JSA. Percutaneous nephrostomy in obstructing pelvic malignancy does not facilitate further oncological treatment. Int Urol Nephrol 2020; 52:1625-1628. [PMID: 32319003 DOI: 10.1007/s11255-020-02466-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The optimal management of patients with ureteric obstruction in advanced malignancy is unclear. How quality of life is affected by a nephrostomy and how many of these patients undergo further oncological treatment remains uncertain. The objective of this retrospective multicentre study was to look at the outcomes of patients who had percutaneous nephrostomy insertion for malignancy. METHODS We identified patients who had a nephrostomy inserted for ureteric obstruction due to malignancy at our institution from January 2015 to December 2018. We obtained data retrospectively from our electronic patient record system. Patients who had nephrostomy insertion for other causes such as ureteric calculi or injury were excluded from the study. RESULTS 105 patients underwent nephrostomy insertion during this time interval. 51.42% patients (n = 54) had urological malignancies (bladder and/or prostate cancer). The median LOS was 14 days (range 1-104 days) post-procedure and 39.04% (n = 41) had at least one 30-day readmission to hospital. The average starting creatinine level was 348 mmol/L (range 49-1133) and the average creatinine at discharge was 170 mmol/L (range 44-651). Although the average change in the creatinine (190 mmol/L) is statistically significant (p < 0.001), it did not seem to prolong life of the patients. Only 26 (24.76%) patients were alive (all-cause mortality) at the end of the 4-year period with an average life expectancy of 139 days following nephrostomy. Only 30.47% (n = 32) patients underwent further oncological treatment. CONCLUSION In our series, most patients who had nephrostomy insertion for ureteric obstruction due to malignancy had no further oncological treatment following insertion. Percutaneous nephrostomy is a procedure not without associated morbidity and does not always prolong survival. Due to the poor prognosis in cases of advanced malignancy, we advocate multi-disciplinary decision-making prior to nephrostomy insertion.
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Affiliation(s)
- Samuel Stephen Folkard
- Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK.
| | - Srijit Banerjee
- Department of Urology, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1FR, UK
| | - Richard Menzies-Wilson
- Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK
| | - Joseph Reason
- Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK
| | - Evangelos Psallidas
- Department of Urology, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1FR, UK
| | - Elliot Clissold
- Department of Urology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK
| | - Ahmad Al-Mushatat
- Department of Urology, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1FR, UK
| | - Saurabh Chaudhri
- Department of Nephrology, Whipps Cross Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK
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16
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Tabib C, Nethala D, Kozel Z, Okeke Z. Management and treatment options when facing malignant ureteral obstruction. Int J Urol 2020; 27:591-598. [PMID: 32253785 DOI: 10.1111/iju.14235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
Malignant ureteral obstruction is an unfortunate finding that can be caused by a wide-ranging number of malignancies with a prognosis of limited survival. Given its presentation and progression, it can be refractory to treatment by traditional single polymeric ureteral stents. With a higher failure rate than causes of benign ureteral obstruction, a number of other options are available for initial management, as well as in cases of first-line therapy failure, including tandem stents, metallic stents, percutaneous nephrostomies and extra-anatomic stents. We reviewed the literature and carried out a PubMed search including the following keywords and phrases: "malignant ureteral obstruction," "tandem ureteral stents," "metallic ureteral stents," "resonance stent," "metal mesh ureteral stents" and "extra-anatomic stents." The vast majority of studies were small and retrospective, with a large number of studies related to metallic stents. Given the heterogenous patient population and diversity of practice, it is difficult to truly assess the efficacy of each method. As there are no guidelines or major head-to-head prospective trials involving these techniques, it makes practicing up to the specific provider. However, this article attempts to provide a framework with which the urologist who is presented with malignant ureteral obstruction can plan in order to provide the individualized care on a case-by-case basis. What is clear is that prospective, randomized clinical trials are necessary to help bring evidence-based medicine and guidelines for patients with malignant ureteral obstruction.
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Affiliation(s)
| | - Daniel Nethala
- Smith Institute for Urology, New Hyde Park, New York, USA
| | - Zachary Kozel
- Smith Institute for Urology, New Hyde Park, New York, USA
| | - Zeph Okeke
- Smith Institute for Urology, New Hyde Park, New York, USA
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17
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The resonance® metallic ureteral stent in the treatment of malignant ureteral obstruction: a prospective observational study. BMC Urol 2019; 19:137. [PMID: 31881875 PMCID: PMC6935232 DOI: 10.1186/s12894-019-0569-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022] Open
Abstract
Background To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. Methods All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). Results Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients’ median age was 67 years (range 28–85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16–372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women’s IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women’s total score tended to be low, the difference between the men’s and women’s scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. Conclusion Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.
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18
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Tatenuma T, Tsutsumi S, Yasui M, Noguchi G, Umemoto S, Kishida T. Outcome of Palliative Urinary Diversion and Observation for Malignant Extrinsic Ureteral Obstruction. J Palliat Med 2019; 23:254-258. [PMID: 31834827 DOI: 10.1089/jpm.2019.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Urologists are often referred to manage the extrinsic malignant ureteral obstruction (MUO) caused by nonurological malignancies. Usually palliative urinary diversion (ureteral stent or nephrostomy) will be performed; however, in the cases of no symptom or poor prognosis, observation (OBS) without any intervention will be selected. There are few reports about outcome of the OBS policy for MUO. Objective: To evaluate the outcome of palliative urinary diversion or OBS for MUO. Design: We retrospectively reviewed the selection of treatment and the prognosis. Setting/Subjects: A total of 151 cases were introduced to our department as MUO between April 2011 and December 2016. Measurements: The patients were divided to immediate palliative urinary diversion (immediate-DIV) or OBS. The latter patients were subdivided to OBS followed by deferred palliative urinary diversion (deferred-DIV), and observation only (OBS-only). Results: There was no significant difference between immediate-DIV and OBS about overall survival (OS) from the consultation. In OBS group, deferred-DIV did not prolong prognosis from the consultation more than OBS-only. In the same way, there was no significant difference between immediate-DIV and deferred-DIV in OS from the intervention. Unfavorable prognostic factors for OS were lack of anticancer treatment after consultation, symptoms of MUO, and gastrointestinal cancer. When we classified the patients by these factors, the group with three factors showed significantly poorer prognosis than the others. Conclusion: Immediate-DIV or OBS did not influence the prognosis in the whole patients. Three prognostic factors that will be judged by urologists easily might be useful for the indication and timing of palliative urinary diversion.
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Affiliation(s)
- Tomoyuki Tatenuma
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan.,Department of Urology, Kanagawa Prefectural Ashigarakami Hospital, Yokohama, Japan
| | - Sogo Tsutsumi
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Yasui
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Go Noguchi
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Susumu Umemoto
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
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19
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Prentice J, Amer T, Tasleem A, Aboumarzouk O. Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review. J R Soc Med 2019; 111:125-135. [PMID: 29648512 DOI: 10.1177/0141076818766725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over the last thirty years, the management of Malignant Ureteric Obstruction (MUO) has evolved from a single disciplinary decision to a multi-disciplinary approach. Careful consideration must be given to the risks and benefits of decompression of hydronephrosis for an individual patient. There is a lack of consensus of opinion as well as strong evidence to support the decision process. Outcomes that were identified amongst patients undergoing treatment for MUO included prognosis, quality of life (QOL), complications, morbidity and prognostication tools. A total of 63 papers were included. Median survival was 6.4 months in the 53 papers that stated this outcome. Significant predictors to poor outcomes included low serum albumin, hyponatremia, the number of malignancy related events, and performance status of 2 or worse on the European cooperative cancer group. We propose a multi-centre review of outcomes to enable evidence-based consultations for patients and their families.
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Affiliation(s)
- Joanna Prentice
- 1 Department of Urology, Queen Elizabeth University Hospital Campus, Glasgow G51 4TF, UK
| | - Tarik Amer
- 1 Department of Urology, Queen Elizabeth University Hospital Campus, Glasgow G51 4TF, UK.,2 Urological Research Unit, Queen Elizabeth University Hospital Campus, Glasgow G51 4TF, UK
| | - Ali Tasleem
- 3 University College London Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Omar Aboumarzouk
- 1 Department of Urology, Queen Elizabeth University Hospital Campus, Glasgow G51 4TF, UK.,2 Urological Research Unit, Queen Elizabeth University Hospital Campus, Glasgow G51 4TF, UK.,4 College of Medical Veterinary and Life Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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20
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Chang HL, Lim HW, Su FH, Tsai ST, Wang YW. Win or Lose? Percutaneous Nephrostomy for a Terminal-Stage Cervical-Cancer Patient Featuring Obstructive Uropathy. J Palliat Care 2019. [DOI: 10.1177/082585970602200111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- He-Ling Chang
- Department of Family Medicine, Heart Lotus Palliative Ward, Buddhist Tzu Chi General Hospital, Hualien
| | - Huey-Wen Lim
- Department of Family Medicine, Heart Lotus Palliative Ward, Buddhist Tzu Chi General Hospital, Hualien
| | - Fu-Hsiung Su
- Department of Family Medicine, Tao-Yuan General Hospital, Tao-Yuan
| | - Shih-Tzu Tsai
- Department of Family Medicine, Heart Lotus Palliative Ward, Buddhist Tzu Chi General Hospital, Hualien
| | - Ying-Wei Wang
- Department of Family Medicine, Heart Lotus Palliative Ward, Buddhist Tzu Chi General Hospital, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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21
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Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure. Int J Clin Oncol 2018; 24:306-312. [PMID: 30298199 DOI: 10.1007/s10147-018-1348-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the clinical outcomes of stent placement for malignant extrinsic ureteral obstruction (MUO) and predictive factors for stent failure. METHODS We retrospectively analyzed clinical data for 91 patients with radiologically significant hydronephrosis due to MUO who underwent successful stent placement. In total, 132 ureters were stented for the decompression. Factors related to stent failure were analyzed with a Cox proportional hazards model. RESULTS Stent failure occurred in 25 ureters in 20 patients. The median interval to failure was 63 days. The multivariate analysis showed that the significant predictors of stent failure were bladder invasion and severe hydronephrosis before the stent insertion. The patients were divided into three groups based on these two factors: low-risk (neither factor; 85 patients), intermediate-risk (one factor; 37), and high-risk (both factors; 10). The median stent failure-free survival rate at 3 months was 94.8% in the low-risk, 71.8% in the intermediate-risk and 55.6% in the high-risk group, respectively. Of the ureters with stent failure, there was successful re-replacement of internal stents in 3 low-risk, 6 intermediate-risk and no high-risk ureters. Replacement by nephrostomy was done in 2 low-risk, 5 intermediate-risk and 7 high-risk ureters. CONCLUSION The patients considered at low-risk could be managed without stent failure by internal stenting. However, the patients at high-risk may require the consideration of nephrostomy or other alternatives as the initial treatment. Our stratification model may allow better risk stratification for patients with regard to ureteral stenting, helping to identify patients for whom ureteral stenting is indicated.
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Affiliation(s)
- Hiroshi Matsuura
- Department of Urology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie, 510-8561, Japan.
| | - Shigeki Arase
- Department of Urology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie, 510-8561, Japan
| | - Yasuhide Hori
- Department of Urology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie, 510-8561, Japan
- Department of Urology, Kameyama Nephro-Urological Clinic, 1488-215 Sakaemachi, Kameyama, Mie, 519-0111, Japan
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22
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Faba OR, Tyson MD, Artibani W, Bochner BH, Burkhard F, Gilbert SM, Kälble T, Madersbacher S, Seiler R, Skinner EC, Thalmann G, Thüroff J, Wiklund P, Hautmann R, Palou J. Update of the ICUD-SIU International Consultation on Bladder Cancer 2018: urinary diversion. World J Urol 2018; 37:85-93. [PMID: 30238399 DOI: 10.1007/s00345-018-2484-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/10/2018] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d'Urologie on Bladder Cancer Urinary Diversion (UD). METHODS A detailed analysis of the literature was conducted reporting on the different modalities of UD. For this updated publication, an exhaustive search was conducted in PubMed for recent relevant papers published between October 2013 and August 2018. Via this search, a total of 438 references were identified and 52 of them were finally eligible for analysis. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine. RESULTS The incidence of early complications has been reported retrospectively in the range of 20-57%. Unfortunately, only a few randomized controlled studies exist within the field of UD. Consequently, almost all studies used in this report are of level 3-4 evidence including expert opinion based on "first principles" research. CONCLUSIONS Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for lifelong follow-up. Progress has been made to prevent complications implementing robotic surgery and fast track protocols. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good results.
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Affiliation(s)
- Oscar Rodríguez Faba
- Urological Oncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, C/Cartagena, 340-350, 08025, Barcelona, Spain.
| | - Mark D Tyson
- Department of Urology, Mayo Clinic, Scottsdale, USA
| | - Walter Artibani
- Urology Clinic, Verona Integrated University Hospital, Verona, Italy
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Fiona Burkhard
- Department of Urology, Inselspital Bern, Bern, Switzerland
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Tilman Kälble
- Urology and Pediatric Urology Clinic, Klinikum Fulda, Fulda, Germany
| | | | - Roland Seiler
- Uro-Oncology and Prostate Centre, Department of Urology, Inselspital Bern, Bern, Switzerland
| | - Ella C Skinner
- Urologic Oncology, Department of Urology, Stanford University, Stanford, USA
| | - George Thalmann
- Uro-Oncology and Prostate Centre, Department of Urology, Inselspital Bern, Bern, Switzerland
| | - Joachim Thüroff
- Department of Urology, University Clinic Mannheim, Mannheim, Germany
| | - Peter Wiklund
- Department of Urology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Solna, Sweden
| | | | - Joan Palou
- Urological Oncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, C/Cartagena, 340-350, 08025, Barcelona, Spain
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Asakawa J, Iguchi T, Tamada S, Ninomiya N, Kato M, Yamasaki T, Nakatani T. Treatment outcomes of ureteral stenting for malignant extrinsic ureteral obstruction: a comparison between polymeric and metallic stents. Cancer Manag Res 2018; 10:2977-2982. [PMID: 30214292 PMCID: PMC6118249 DOI: 10.2147/cmar.s172283] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To compare treatment outcomes, more specifically patency rate, of polymeric and metallic stents for malignant ureteral obstruction. Patients and methods Between August 2007 and September 2017, we retrospectively analyzed the data of 92 patients (126 ureters) having a diagnosis of malignant extrinsic ureteral obstruction treated with indwelling ureteral stents (polymeric and full-length metallic stents). Of these patients, 35 (54 ureters) were treated with polymeric stents and 57 (72 ureters) with a Resonance® metallic stent. The observation period was censored to 1 year. Survival rate in cases of malignant ureteral obstruction was calculated, and the relationship between the causes of ureteral obstruction, the stent type, and the patency rate was evaluated. Results The median observation period was 145 days, with a median survival time of 258 days. The stent patency rate was 70.9% at 1 year, regardless of stent type. Stent occlusion was observed in 20 patients (33 ureters). According to stent type, occlusion of the polymeric and metallic stents was identified in 12 (22%) and 8 (11%) cases, respectively. The clinical features associated with stent failure were assessed. In univariate analysis, the patency rate was significantly better for the metallic stent than for the polymeric stent (1-year patency rate; 78.4%, 61.1%, respectively, HR, 2.15; 95% CI, 1.07-4.33; p=0.031). However, the patency rate among patients with abdominal dissemination, lymph node metastasis, and direct compression by tumor was not significantly different. Conclusion Indwelling ureteral stents, particularly metallic stents, are effective for the treatment of malignant ureteral obstruction.
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Affiliation(s)
- Jumpei Asakawa
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Taro Iguchi
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Satoshi Tamada
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Noriko Ninomiya
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Minoru Kato
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Takeshi Yamasaki
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
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O'Connor EM, Nason GJ, Kiely EA. Urological Management of Extramural Malignant Ureteric Obstruction: A Survey of Irish Urologists. Curr Urol 2018; 11:21-25. [PMID: 29463973 DOI: 10.1159/000447190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction The absence of guidelines in the management of extramural malignant ureteric obstruction leads to confusion in decision making and in the interaction between urology and other clinical disciplines. In this study, we surveyed consultant urologists with the goal of achieving a better consensus on optimal management options. Methods A multiple choice survey was sent via the online survey tool "SurveyMonkey" to all consultant urologists practicing in the Republic of Ireland. Results There was a response rate of 57.5% (n = 23). Twenty-two (96%) consultants consider the use of percutaneous nephrostomy with placement of antegrade ureteric stent but only 22% (n = 5) would consider using a metallic stent. Eleven (48%) respondents favor retrograde stenting in the first instance with an equal proportion choosing an antegrade method. Nine (39%) consultants perform the initial stent change at 4-6 months, 8 (35%) at 2-4 months, and 1 at < 2 months and 6-10 months respectively. Total 59% (n = 13) of respondents felt that the duration of expected patient survival influenced their decision and agreement to stent with 42% (n = 8) saying this survival would need to be > 6 months and 82% (n = 18) were generally happy with the level of ongoing communication between urology and the primary service managing the patient. Conclusion There is a lack of consensus regarding the management of this challenging problem, particularly with regard to timing of first stent change and whether to initially use an antegrade or retrograde approach. This reflects the heterogeneous patient cohort and the important factors of life expectancy and patient co-morbidities.
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Affiliation(s)
| | - Gregory J Nason
- Department of Urology, Cork University Hospital, Wilton, Ireland
| | - Eamon A Kiely
- Department of Urology, Cork University Hospital, Wilton, Ireland
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25
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Asakawa J, Iguchi T, Tamada S, Ninomiya N, Kato M, Yamasaki T, Nakatani T. Outcomes of indwelling metallic stents for malignant extrinsic ureteral obstruction. Int J Urol 2017; 25:258-262. [DOI: 10.1111/iju.13500] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jumpei Asakawa
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Taro Iguchi
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Satoshi Tamada
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Noriko Ninomiya
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Minoru Kato
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Takeshi Yamasaki
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Tatsuya Nakatani
- Department of Urology; Osaka City University Graduate School of Medicine; Osaka Japan
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26
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[Management of ureteral obstruction : Value of percutaneous nephrostomy and ureteral stents]. Urologe A 2016; 55:1497-1510. [PMID: 27787581 DOI: 10.1007/s00120-016-0253-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ureteral obstruction represents a heterogeneous disease pattern and is treated by ureteral stenting or percutaneous nephrostomy (PCN) depending on the necessity. The benefits of urinary diversion with ureteral stenting or PCN in malignant ureteral obstruction (MUO) for patient survival are only moderate. No differences have been found between ureteral stenting and PCN in MUO with regard to median patient survival and complication rates. In cases of MUO there is currently no evidence that urinary diversion improves the quality of life. Alternative concepts of ureteral stenting, such as tandem ureteral stents, metallic ureteral stents or metal mesh ureteral stents have not yet shown clear benefits. In benign ureteral obstruction, prospective randomized studies have demonstrated comparable quality of life after PCN or ureteral stenting. The method of choice for urinary diversion is influenced by the recommendations, personal experience of the clinician and the availability of the method.
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27
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Balogun BO, Owolabi JI, Saliu AN, Bankole MA. Role of ultrasound-guided percutaneous antegrade pyelography in malignant obstructive uropathy: A Nigerian experience. Niger Med J 2015; 56:225-8. [PMID: 26229234 PMCID: PMC4518342 DOI: 10.4103/0300-1652.160408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ultrasound-guided percutaneous nephrostomy of the renal pelvis is a technique that is widely acceptable especially when contrast media is introduced in the procedure of antegrade pyelography. It is a relatively safe procedure that effectively improves renal function in obstructed kidneys. It can be performed in most cases as an alternative to retrograde pyelography. We present our experience and its role in obstructive uropathy due to malignancy.
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Affiliation(s)
| | - James Idowu Owolabi
- Department of Radiology, Lagos State University Teaching Hospital, Ikeja, Nigeria
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Cordeiro MD, Coelho RF, Chade DC, Pessoa RR, Chaib MS, Colombo-Júnior JR, Pontes-Júnior J, Guglielmetti GB, Srougi M. A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients. BJU Int 2015; 117:266-71. [PMID: 25327474 DOI: 10.1111/bju.12963] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk-stratification model for treatment decisions. PATIENTS AND METHODS We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan-Meier survival estimates at 1, 6 and 12 months, and log-rank tests. RESULTS The median (range) survival was 144 (0-1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). CONCLUSIONS Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
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Affiliation(s)
- Maurício D Cordeiro
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Rafael F Coelho
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Daher C Chade
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo R Pessoa
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Mateus S Chaib
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - José R Colombo-Júnior
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - José Pontes-Júnior
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Giuliano B Guglielmetti
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
| | - Miguel Srougi
- Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School and Institute of Cancer Estate of Sao Paulo, Sao Paulo, Brazil
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29
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Bigum LH, Spielmann ME, Juhl G, Rasmussen A. A qualitative study exploring male cancer patients’ experiences with percutaneous nephrostomy. Scand J Urol 2014; 49:162-8. [DOI: 10.3109/21681805.2014.938694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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30
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Bhojwani N, Hartman JB, Ahmed M, Morgan R, Davidson JC. Management of ureteral obstruction in crossed fused renal ectopia: A case report. Can Urol Assoc J 2014; 8:E752-4. [PMID: 25408820 DOI: 10.5489/cuaj.2050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Crossed fused renal ectopia is a rare congenital malformation. We describe a case in which a 58-year-old male with left-sided crossed fused renal ectopia presented with urinary bladder outlet obstruction due to metastatic prostate adenocarcinoma. Glomerular filtration rate (GFR) was 13 mL/min, creatinine 4 mg/dL, and blood urea nitrogen (BUN) 58 mg/dL. The patient underwent successful image-guided placement of percutaneous nephrostomy tubes which were later converted to nephroureteral stents. Labs improved to a GFR of 28 mL/min, creatinine of 2.4 mg/dL, and BUN of 41 mg/dL. In this case standard image-guided renal decompression techniques were effective in treating a patient with crossed fused renal ectopia.
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Affiliation(s)
- Nicholas Bhojwani
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | | | - Manzoor Ahmed
- Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Morgan
- Case Western Reserve University School of Medicine, Cleveland, OH; ; Explorys Inc., Cleveland, OH
| | - Jon C Davidson
- Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, Cleveland, OH
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31
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Fiuk J, Bao Y, Calleary JG, Schwartz BF, Denstedt JD. The use of internal stents in chronic ureteral obstruction. J Urol 2014; 193:1092-100. [PMID: 25463984 DOI: 10.1016/j.juro.2014.10.123] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Despite the lack of a well delineated definition, chronic ureteral obstruction imposes significant quality of life loss, increased pathological morbidity and risk of mortality as well as substantial economic burden. Ureteral stenting serves as an important therapeutic option to alleviate obstruction. Thus, we assessed the recently published literature on chronic ureteral obstruction; treatment options; types, benefits and shortcomings of current ureteral stents; as well as outcomes and complications of chronic ureteral stenting, with the goal of providing concise management guidelines. MATERIALS AND METHODS A systemic literature review was performed on Embase™, PubMed®, Cochrane Controlled Trials Register and Google Scholar™ on ureteral obstruction and internal ureteral stents. Relevant reviews, original research articles and their cited references were examined, and a synopsis of original data was generated on a clinically oriented basis. RESULTS Chronic ureteral obstruction can be classified into compression that is either intrinsic or extrinsic to the ureteral wall, or obstruction that is of a benign or malignant origin. Patients with malignant ureteral obstruction generally have a poor prognosis and are often difficult to treat. The aim of stenting is to adequately drain the upper urinary tracts while minimizing hospitalization and the negative impact on quality of life. Facing the challenge of chronic ureteral obstruction, novel stents with new compositions, materials, coatings and designs have been developed. Metallic stents are emerging as efficacious and financially viable alternatives. Early stent related complications include iatrogenic injury, stent migration or patient discomfort, while late complications include infection, difficulties with stent exchange, hardware malfunction, infection and stent encrustation. CONCLUSIONS Stenting in chronic ureteral obstruction is a complex and challenging problem. Much work is being done in this area and many options are being explored.
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Affiliation(s)
- Julia Fiuk
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Yige Bao
- Division of Urology, Department of Surgery and Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Urology, West China Hospital, Sichuan University, West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - John G Calleary
- Department of Urology, North Manchester General Hospital, Manchester, United Kingdom
| | - Bradley F Schwartz
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - John D Denstedt
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois.
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Koo KC, Yoo H, Kim KH, Park SU, Han KS, Rha KH, Hong SJ, Yang SC, Chung BH. Prognostic impact of synchronous second primary malignancies on the overall survival of patients with metastatic prostate cancer. J Urol 2014; 193:1239-44. [PMID: 25444987 DOI: 10.1016/j.juro.2014.10.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We determined the prognostic impact of a synchronous second primary malignancy on overall survival in patients with metastatic prostate cancer. Identifying features that stratify the risk of overall survival is critical for judiciously applying definitive therapy. MATERIALS AND METHODS We retrospectively analyzed the records of 582 consecutive patients with prostate cancer diagnosed with metastasis between May 7, 1998 and August 27, 2011. Patient age, body mass index, ECOG performance status, Charlson comorbidity index, prostate specific antigen, T and N stages, Gleason and ASA® scores, progression to castration resistant prostate cancer, prior local treatments and synchronous second primary malignancies at metastasis were assessed. A synchronous second primary malignancy was defined as a cytologically or histologically proven solid malignancy. Cox proportional hazards regression analysis was done to estimate overall survival by second primary type and evaluate predictive variables. RESULTS A total of 164 patients (28.1%) had a synchronous second primary malignancy, of which colorectal (9.1%), stomach (7.3%) and lung (7.1%) cancers were the most prevalent types. During a median followup of 34.1 months patients without a synchronous second primary malignancy had a significantly higher overall survival rate than those with lung or stomach cancer. However, men without a second malignancy had outcomes comparable to those in men with colorectal cancer. Clinical stage T4 or greater, ASA score 1 or greater and lung or stomach cancer were independent predictors of overall mortality. CONCLUSIONS A substantial proportion of patients with metastatic prostate cancer present with a synchronous second primary malignancy. Definitive therapy targeting prostate cancer may confer a limited survival benefit in patients with synchronous lung or stomach cancer.
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Affiliation(s)
- Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hanna Yoo
- Biostatistics Collaboration Laboratory, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hong Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Un Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Seok Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Song SH, Pak S, Jeong IG, Kim KS, Park HK, Kim CS, Ahn H, Hong B. Outcomes of stent-change therapy for bilateral malignancy-related ureteral obstruction. Int Urol Nephrol 2014; 47:19-24. [PMID: 25315466 DOI: 10.1007/s11255-014-0858-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the long-term outcomes of stent-change therapy for malignancy-related ureteral obstruction in terms of renal function outcomes. METHODS We retrospectively reviewed 87 consecutive patients who underwent bilateral ureteral stenting for malignant bilateral ureteral obstruction. Predictive value of clinical variables, such as age, sex, comorbidities, renal function at time of stenting, and securing of the dominant functional kidney or both with early percutaneous nephrostomy (PCN) conversion on renal function preservation, were analyzed. RESULTS The mean serum Cr level was 3.3 mg/dl at the time of bilateral stenting, which significantly decreased to 1.6 mg/dl at 6 months post-stenting and progressively deteriorated to 2.3 mg/dl at 3 years post-stenting. Chronic kidney disease (CKD) stage 4 or 5 developed in 18.3% of patients at 6 months post-stenting and in 57.2% at 3 years post-stenting. During the follow-up period, 12 patients (13.8%) had PCN conversion. Patients who had early PCN conversion before progression to CKD 4 or more tended to show a better renal function outcome than patients with CKD 4 or more who had late PCN conversion or no conversion. Multivariate analysis showed that an age older than 55 years, diabetes, and an eGFR<60 before obstructive symptoms or signs were significant predictive factors for the development of CKD stage 4 or more. CONCLUSIONS To preserve renal function, patients with bilateral malignant ureteral obstruction, especially those aged 55 or more or with diabetes or poor baseline renal function, should be considered for early PCN conversion in the dominant functional kidney or both.
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Affiliation(s)
- Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Pungnap-Dong 388-1, Songpa-Gu, Seoul, Korea
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Azuma T, Nagase Y, Oshi M. Prognostic marker for patients with malignant ureter obstruction. Clin Genitourin Cancer 2013; 11:353-6. [PMID: 23787166 DOI: 10.1016/j.clgc.2013.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/12/2012] [Accepted: 07/14/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the relationship between overall survival (OS) and prognostic risk factors for patients with malignant ureteral obstruction. PATIENTS AND METHODS We retrospectively evaluated 214 patients who had received a nephrostomy for ureteral obstruction because of malignancy. Univariate and multivariate Cox regression models addressed OS. RESULTS The median OS was 6.4 months. The OS at 1, 3, 6, and 12 months were 89.5%, 72.4%, 53.0%, and 26.5%, respectively. Using univariate Cox regression analysis, serum levels of creatinine (P = .0131), albumin (P < .0001), sodium (P < .0001), potassium (P = .0141), corrected calcium (P = .0167), C-reactive protein (P < .0001), white blood cell count (P = .0246), and the number of events related to malignant dissemination (P < .0001) were associated with OS. Using multivariate Cox regression analysis, serum levels of albumin (P = .0147), sodium (P = .0046), C-reactive protein (P < .0001), and the number of events related to malignant dissemination (P = .0002) were independent predictors of OS. CONCLUSION Low serum levels of albumin and sodium and the number of events related to malignant dissemination before PCN were independent factors associated with a poor prognosis. High serum C-reactive protein level was also associated with a poor prognosis using multivariate analysis.
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Affiliation(s)
- Takeshi Azuma
- Department of Urology, Tokyo Metropolitan Tama Medical Center, 2-9-2 Musashi-dai, Fuchu, Tokyo, Japan.
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35
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Yu SH, Ryu JG, Jeong SH, Hwang EC, Jang WS, Hwang IS, Yu HS, Kim SO, Jung SI, Kang TW, Kwon DD, Park K, Hwang JE, Kim GS. Predicting factors for stent failure-free survival in patients with a malignant ureteral obstruction managed with ureteral stents. Korean J Urol 2013; 54:316-21. [PMID: 23700497 PMCID: PMC3659225 DOI: 10.4111/kju.2013.54.5.316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/04/2013] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. Materials and Methods We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. Results A univariate analysis indicted that hypoalbuminemia (<3.5 g/dL; hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.21 to 4.86; p=0.012), elevated CRP (≥1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS ≥1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. Conclusions A mid or lower ureteral obstruction, GPS ≥1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.
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Affiliation(s)
- Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Misra S, Coker C, Richenberg J. Percutaneous nephrostomy for ureteric obstruction due to advanced pelvic malignancy: have we got the balance right? Int Urol Nephrol 2013; 45:627-32. [DOI: 10.1007/s11255-013-0458-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/21/2013] [Indexed: 12/15/2022]
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37
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[Diagnostic puncture of the renal pelvis: avoidance of urinary diversion in cases of hydronephrosis and non-specific fever]. Urologe A 2013; 51:1438-43. [PMID: 22801818 DOI: 10.1007/s00120-012-2971-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There are individual cases especially of elderly or palliative patients with hydronephrosis and non-specific fever where a urinary diversion should be avoided in favor of quality of life. For these purposes this study presents the method and the results obtained with a diagnostic puncture of the renal pelvis. METHODS Demographic data, indications for urinary diversion and the disease leading to hydronephrosis were retrospectively recorded from the operation reports of all percutanous nephrostomy procedures from 2007 to 2012. All cases in which a diagnostic puncture of the renal pelvis was conducted to potentially avoid placing a nephrostomy tube were considered separately. RESULTS From January 2007 to May 2012 a total of 476 percutanous nephrostomies were accomplished in this department. The most frequent indication for nephrostomy was acute renal failure in 55.3% of cases followed by septic laboratory constellations (33.1%) and colic (10.9%). Of the 148 cases of hydronephrosis combined with sepsis, a diagnostic puncture of the renal pelvis was accomplished in 20.1%. In these cases the hydronephrosis had an underlying urological origin in 71.0%, reaching statistical significance with reference to the complete collective (p=0.034). In 21 out of 34 nephrology units (61.8%) it was possible to avoid nephrostomy due to clear urine and immediate urinanalysis without any evidence for infection. In the other cases a nephrostomy tube was placed. CONCLUSIONS Using a diagnostic puncture of the renal pelvis a nephrostomy could be avoided in over 50% of cases with a combination of hydronephrosis and non-specific fever in favor of quality of life.
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Abbasi A, Wyre HW, Ogan K. Use of full-length metallic stents in malignant ureteral obstruction. J Endourol 2013; 27:640-5. [PMID: 23237309 DOI: 10.1089/end.2012.0448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Malignant ureteral obstruction (MUO) has traditionally been a difficult problem to manage. Indwelling ureteral stents have a failure rate up to 50%, necessitating the placement of percutaneous nephrostomy (PCN) drainage, which has associated complications and impacts on quality of life. Recently, metallic ureteral stents have emerged as a treatment for extrinsic ureteral obstruction. We present our initial experience using Resonance (Cook Urologic, Spencer, IN) full-length metallic stents for MUO. MATERIALS AND METHODS 20 patients (27 renal units) with advanced cancers and MUO were treated with metallic stents. Patients were followed prospectively to evaluate for recurrent obstruction. Perioperative morbidity and overall mortality were recorded. RESULTS The mean patient age was 49.9 years (SD 18.9). The primary malignancies causing MUO were gastrointestinal (8), gynecologic (6), genitourinary (2), or other (4). All but two renal units had been previously treated with traditional stents. Eight out of 20 (40%) patients required further intervention for their MUO. Mean time to failure for the metallic stents was 7.4 months (222 days). Two patients required conversion to percutaneous drainage. Five patients required change to traditional stents (3) or removal of metallic stents. At the last follow-up, sixteen patients had died. Fourteen of the sixteen patients died with functioning metallic stents in place, although one patient who initially had bilateral metallic stent placements had a left stent removed due to migration. Of the remaining four living patients, two have functioning metallic stents at a mean follow-up of 42 months. DISCUSSION MUO remains a difficult clinical problem in a group of patients with a high mortality. While metallic stents ultimately have a failure rate similar to that of traditional stents, the mean time to failure is longer. Therefore, metallic stents may benefit patients with MUO, because the longer dwell time may eliminate the need for more frequent stent changes or further interventions.
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Affiliation(s)
- Ammara Abbasi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer. Support Care Cancer 2013; 21:1303-11. [DOI: 10.1007/s00520-012-1666-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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Abstract
First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described.
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Affiliation(s)
- Mandeep Dagli
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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Potretzke AM, Chang H, Kryger JV. Technique for Resonance® stent exchange in patients with extrinsic obstruction: description of a novel approach and literature review. J Pediatr Urol 2012; 8:557-9. [PMID: 22370061 DOI: 10.1016/j.jpurol.2012.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/21/2012] [Indexed: 10/28/2022]
Abstract
Malignant ureteral obstruction is a morbid diagnosis and can be difficult to manage. Ureteral stents often fail as the disease progresses. Metallic stents have provided a longer-term option for decompression as they inherently resist compression and require changes left often. However, changing metallic stents is challenging as it cannot be done over a wire as is done with plastic stents. We present a novel technique for safe and efficient exchange of the Resonance(®) metallic stent. We also review the literature on metallic stents.
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Affiliation(s)
- A M Potretzke
- University of Wisconsin - Madison, Department of Urology, Madison, WI 53705, USA.
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Percutaneous nephrostomy versus indwelling ureteral stent in the management of gynecological malignancies. Int J Gynecol Cancer 2012; 22:697-702. [PMID: 22315095 DOI: 10.1097/igc.0b013e318243b475] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aims of this study were to evaluate the efficacy of retrograde ureteral stenting and to identify the predictive factors for potential failure of this technique in women with advanced gynecologic malignancies. METHODS From 2006 to 2010, a retrospective analysis was performed on a total of 75 patients with ureteral obstruction due to gynecologic malignancies. This population was divided into group 1 (n = 50) in which retrograde stent placement was successful, and group 2 (n = 25) in which stent placement failed and subsequent percutaneous nephrostomy tube placement was required. Multivariate analysis was done to identify predictors of the failure of ureteral stent insertion. RESULTS Multivariate analysis revealed that mean preprocedureal serum cystanin C greater than 2.5 mg/L and length of the ureteral obstruction greater than 3 cm were significant predictors of stent failure. Neither the causes nor location of obstruction predicted the need for percutaneous nephrostomy (PCN). No statistical significance was detected among the subgroups of patients with different degrees of hydronephrosis. Statistical significant differences were found between the 2 groups in procedural time, average cost, and mean interval of stent/catheter replacement. However, no statistically significant difference was found in the median survival time and overall stent-related or catheter-related complications between the 2 groups. CONCLUSIONS Retrograde ureteral stenting is a first-line option for managing ureteral obstruction caused by gynecologic malignancies. However, in cases where the preprocedureal mean serum cystanin C is greater than 2.5 mg/L and the length of the ureteral obstruction segment is greater than 3 cm, these patients may be better served by percutaneous drainage.
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Friedlander JI, Duty BD, Okeke Z, Smith AD. Obstructive Uropathy from Locally Advanced and Metastatic Prostate Cancer: An Old Problem with New Therapies. J Endourol 2012; 26:102-9. [DOI: 10.1089/end.2011.0227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Justin I. Friedlander
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Brian D. Duty
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Zeph Okeke
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Arthur D. Smith
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Lapitan MCM, Buckley BS. Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: a prospective cohort. J Obstet Gynaecol Res 2011; 37:1061-70. [PMID: 21481096 DOI: 10.1111/j.1447-0756.2010.01486.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Obstructive uropathy is a recognized complication in advanced cervical cancer. Urinary diversion is commonly used to bypass the obstruction and improve renal function. The degree of survival benefit that diversion offers is not well established and its impact on quality of life (QoL) is uncertain. This study considered these factors in order to inform treatment decisions. METHODS This study examined a prospective cohort of patients with advanced cervical cancer and obstructive uropathy in Manila, Philippines. Age, cancer treatment status, comorbidities, serum creatinine level, degree of obstructive uropathy and QoL were recorded at baseline. Patients with creatinine values >150 µmol/L, or who were being considered for radiotherapy or nephrotoxic chemotherapy or manifesting uncontrolled or recurrent uropathy-related urinary tract infection, were offered diversion. Follow-up data collection was at 3, 6, 9 and 12 months from cohort entry. RESULTS Of the 230 patients invited, 205 patients joined the cohort. Complete data were available for 198, of whom 93 underwent diversion, 56 required diversion but elected not to receive it, and 49 did not require it. Although survival at 12 months among those who underwent diversion was no greater than among those who required but elected not to receive the procedure, diversion was associated with significantly improved chance of survival in the shorter term. There was no significant difference in the QoL between the groups throughout the study. CONCLUSION With no evidence of an impact on QoL, the decision to offer diversionary surgery might be based solely on a survival benefit, which is modest but potentially important to patients.
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Affiliation(s)
- Marie Carmela M Lapitan
- Department of Surgery, College of Medicine, Philippine General Hospital, Manila, Philippines.
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Kamiyama Y, Matsuura S, Kato M, Abe Y, Takyu S, Yoshikawa K, Arai Y. Stent failure in the management of malignant extrinsic ureteral obstruction: risk factors. Int J Urol 2011; 18:379-82. [PMID: 21518020 DOI: 10.1111/j.1442-2042.2011.02731.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is still controversy surrounding the indications for performing either a retrograde ureteral stent or percutaneous nephrostomy to manage malignant extrinsic ureteral obstruction (MEUO). We retrospectively analyzed 53 patients who underwent a decompression of MEUO using retrograde ureteral stent. Ureteral stent failure occurred in 18 of 53 patients (34%). Multivariate analysis showed that gastrointestinal cancer as the primary disease, poor preoperative performance status and severe preoperative hydronephrosis were independent predictors of stent failure. Based on the present data, we propose an algorithm for the management of MEUO.
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Affiliation(s)
- Yoshihiro Kamiyama
- Department of Urology, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
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Izumi K, Mizokami A, Maeda Y, Koh E, Namiki M. Current outcome of patients with ureteral stents for the management of malignant ureteral obstruction. J Urol 2010; 185:556-61. [PMID: 21168872 DOI: 10.1016/j.juro.2010.09.102] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE We analyzed the prognostic factors associated with overall survival and predictive factors of stent failure in patients treated with an indwelling retrograde ureteral stent for malignant ureteral obstruction. MATERIALS AND METHODS Among 186 Japanese patients treated with an indwelling retrograde ureteral stent for ureteral obstruction from January 2005 to March 2010, 61 with malignant ureteral obstruction and 95 ureteral units were analyzed retrospectively. RESULTS Median survival was estimated at 228 days. Unfavorable prognostic factors of overall survival were no treatment after indwelling retrograde ureteral stent placement (p = 0.023) and a serum creatinine before indwelling retrograde ureteral stent placement of 1.2 mg/dl or greater (p = 0.016). Overall survival differed significantly among cancer groups (p <0.001) as did stent failure-free survival (p = 0.011). Overall survival differed significantly among 3 risk groups divided according to the score calculated with regard to prognostic factors (p <0.001). CONCLUSIONS Gynecologic cancer was a significant favorable predictor of stent failure-free survival. Patients treated with an indwelling retrograde ureteral stent for malignant ureteral obstruction were divided into 3 groups, which showed significant differences in overall survival. This risk classification may help urologists predict survival time.
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Affiliation(s)
- Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
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Modi AP, Ritch CR, Arend D, Walsh RM, Ordonez M, Landman J, Gupta M, Knudsen BE. ACE2 and angiotensin 1-7 are increased in a human model of cardiovascular hyporeactivity: pathophysiological implications. J Endourol 2010; 24:1189-93. [PMID: 20575695 DOI: 10.1089/end.2010.0121] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND ACE and ACE2 produce angiotensin II (Ang II), a vasopressor that induces cardiovascular remodeling, and Ang 1-7, a vasodilator with an antiremodeling effect. While Ang 1-7 has antiarrhythmic properties, at higher concentration it may induce ventricular tachycardia and sudden death. ACE2, therefore, may play an essential role in blood pressure homeostasis, in the long-term complications of hypertension (cardiovascular remodeling), and in the induction of cardiac electric abnormalities. This study evaluated the levels of ACE2 and Ang 1-7 in Bartter's/Gitelman's patients (BS/GS) who have elevated Ang II and endogenous blockade of Ang II type 1 receptor signaling compared with healthy subjects (C) and essential hypertensives (EH). BS/ GS patients were also considered because of their predisposition to cardiac arrhythmias, which has yet to be completely clarified. METHODS Mononuclear cell ACE2 and Ang 1-7 were evaluated using western blot. RESULTS One-way ANOVA showed that ACE2 and Ang 1-7 levels were significantly different between the three groups (p=0.0074 and p=0.0001, respectively). Post-hoc analysis (Tukey's HSD) showed that both ACE2 (1.59+/-0.63) and Ang1-7 (2.26+/-1.18) were significantly elevated in BS/GS compared with either C (0.98+/-0.45; p=0.008; 1.12+/-0.48, p=0.002, respectively) or EH (1.06+/-0.24; p=0.043; 0.72+/-0.28; p=0.0001, respectively). ACE2 and Ang 1-7 directly correlated only in BS/GS (r=0.91, p<0.0003). CONCLUSIONS The elevated ACE2 and Ang 1-7 in BS/ GS patients mirror those in hypertensives and are in line with the clinical, hemodynamic and pathophysiological characteristics of BS/GS, likely contributing to them. In consideration of the clinical picture of these syndromes, the opposite of hypertension, the results of this study further strengthen the importance of the ACE2/Ang 1-7 system in the regulation of vascular tone and cardiovascular biology.
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Affiliation(s)
- Achal P Modi
- Department of Urology, The Ohio State University Medical Center, Columbus, Ohio, USA
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Gerullis H, Ecke TH, Schwartmann K, Heuck CJ, Eimer C, Bagner JW, Kocheril S, Otto T. Nephrocutaneous Bypass in Ureteral Obstruction. Urology 2010; 76:480-5. [DOI: 10.1016/j.urology.2009.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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Sountoulides P, Pardalidis N, Sofikitis N. Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues. J Endourol 2010; 24:129-42. [PMID: 19954354 DOI: 10.1089/end.2009.0157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.
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