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Branger N, Lorusso V, Pacchetti A, Lannes F, Sypre D, Espinosa F, Manceau C, Rybikowski S, Brunelle S, Maubon T, Salem N, Gravis G, Pignot G, Walz J. Impact of long-term indwelling JJ stent on renal volume and renal function. Minerva Urol Nephrol 2023; 75:752-760. [PMID: 36383182 DOI: 10.23736/s2724-6051.22.04975-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Data is lacking about long-term impact of JJ stents (JJst) on renal parenchyma. The aim of the study was to assess the evolution of renal parenchyma in patients with JJst indwelling for more than two years, and to find predictive factors for the development of renal atrophy. METHODS Consecutive patients with JJst indwelled for more than 24 months, with a history of cancer, were retrospectively included. Replacements of JJst were scheduled every six months, or earlier in case of premature obstruction. Patient characteristics at the time of insertion of JJst, history of indwelling JJst and most recent data (serum creatinine, cancer status, definite JJst removal, renal volume (RV) with3D software) were recorded. RESULTS With a median follow-up of 4 years, 73 patients were included. The indication of JJst insertion was mostly external compression (65.8%). CT scans were available to assess RV evolution in 66 patients (90.4%). Median shrinkage of RV was higher when JJ stenting was unilateral versus bilateral: -40% (-63; -15) versus -16% (-36; -3), P<0.001. The duration of indwelling JJst was the only statistically significative predictive factor of renal shrinkage in multivariate analysis (OR [CI 95%]: 1.35 [1.10-1.66] P=0.004). Median relative change from baseline in eGFR was -22% (-45%; -5%.). No statistically significant predictive factors of eGFR evolution were found in univariate and multivariate analysis. CONCLUSIONS Unilateral JJst for more than 2 years was associated with a significant shrinkage of renal parenchyma, especially since the duration of the indwelling stent was long.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France -
| | - Vito Lorusso
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Andrea Pacchetti
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - François Lannes
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Davidson Sypre
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Franck Espinosa
- Department of Radiology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Christophe Manceau
- Department of Radiology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Stanislas Rybikowski
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Thomas Maubon
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Naji Salem
- Department of Radiation Therapy, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Gwénaëlle Gravis
- Department of Oncology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Jochen Walz
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
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DE Lorenzis E, Zanetti SP, Boeri L, Albo G, Montanari E. Long-term ureteral JJ stent: useful, useless or harmful? Minerva Urol Nephrol 2023; 75:667-671. [PMID: 37795697 DOI: 10.23736/s2724-6051.23.05541-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Elisa DE Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Stefano P Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Gadelkareem RA, Abdelraouf AM, El-Taher AM, Ahmed AI. Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage? World J Nephrol 2022; 11:146-163. [PMID: 36530794 PMCID: PMC9752243 DOI: 10.5527/wjn.v11.i6.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/29/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mahmoud Abdelraouf
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mohammed El-Taher
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Abdelfattah Ibrahim Ahmed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
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Gu A, Oyo L, Grossmann NC, Wettstein MS, Kaufmann B, Bieri U, Poyet C, Hermanns T, Sulser T, Eberli D, Keller EX. Tumor stent for chronic ureteral obstruction: Which are predictors of stent failure? J Endourol 2021; 36:819-826. [PMID: 34969262 DOI: 10.1089/end.2021.0689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify predictors of UROSOFT® tumor stent failure. According to the manufacturer, this reinforced ureteral stent has a maximal dwell time of 6 months. Nonetheless, stent failure may reduce this maximal dwell time. METHODS All patients undergoing first-time UROSOFT® tumor stent insertion in our institution between 2010 and 2018 were considered for this retrospective analysis. Primary endpoint was stent failure and defined as premature stent exchange or percutaneous nephrostomy insertion. RESULTS 182 patients were available for analysis. Median age was 68 years. Causes for tumor stent placement were extrinsic ureteral obstruction in 144 patients (79 %) and intrinsic obstruction in 38 patients (21 %). Tumor stent failure free survival estimates at 1, 2, 3, 4 and 5 months were 89%, 83%, 76%, 65% and 52%, respectively. Patients with stent failure had significantly higher grade of hydronephrosis, higher urinary culture bacterial growth, higher serum WBC, higher CRP and lower eGFR at the time of re-intervention, compared to patients who underwent regular stent exchange. Of all baseline and perioperative parameters, we found bilateral insertion, intrinsic ureteral obstruction, and urinary tract infection (UTI) at time of tumor stent insertion to be significant and independent predictors of stent failure (all p < 0.05). CONCLUSION Despite a theoretical maximal dwell time of 6 months, around 50% of all cases are subject to premature stent failure. Predictors of stent failure are bilateral insertion, intrinsic ureteral obstruction, and UTI at the time of tumor stent insertion. Preoperative antibiotic therapy may impact on stent failure rate.
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Affiliation(s)
- Alexander Gu
- UniversitätsSpital Zürich, 27243, Urologie, Frauenklinikstrasse 10, Zurich, Switzerland, 8091;
| | - Lisa Oyo
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Switzerland;
| | | | | | - Basil Kaufmann
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Switzerland;
| | - Uwe Bieri
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Switzerland;
| | - Cédric Poyet
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Switzerland;
| | - Thomas Hermanns
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Zürich, Switzerland;
| | - Tullio Sulser
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Switzerland;
| | - Daniel Eberli
- UniversitätsSpital Zürich, 27243, Urologie, Zurich, Zürich, Switzerland;
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Ureteral Stent and Percutaneous Nephrostomy in Managing Malignant Ureteric Obstruction of Gastrointestinal Origin: A 10 Years’ Experience. GASTROINTESTINAL DISORDERS 2020. [DOI: 10.3390/gidisord2040041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Malignant ureteral obstruction (MUO) is variable in presentation and there is no consensus on its management, especially when caused by gastrointestinal (GI) malignancies. Our aim was to describe our experience with this oncological complication. Methods: We retrospectively analyzed the outcomes of ureteral stent and nephrostomy tube (NT) positioning for GI-related MUO from 2010 to 2020. We performed descriptive analysis, survival analysis, and uni- and multi-variate analysis. Results: We included 51 patients. NT was mainly used when bladder involvement occurred and when MUO revealed an ex novo cancer diagnosis. Survival was poorer in patients with new diagnoses and in those receiving no treatment after decompression. Moreover, MUO caused by upper-GI tumors was related to shorter overall survival. Conclusions: GI tumors causing MUO should be considered of poor prognosis. Treatment decisions should be weighted accurately by both specialists and the patient.
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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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Liu Y, Wu K, Lai H, Zeng Z, Zhang B. Clinical application of fluoroscopic guided percutaneous antegrade ureteral stents placement for the treatment of malignant ureteral obstruction. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:453-460. [PMID: 30909269 DOI: 10.3233/xst-180466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy and safety of fluoroscopic guided percutaneous antegrade ureteral stents placement used for treatment of malignant ureteral obstruction. METHODS Between April 2016 and March 2018, fluoroscopic guided percutaneous ureteral stents was performed in 25 patients, including 7 patients (28%) with bilateral obstruction. The most common cancer diagnoses were cervical cancer (28%), rectal cancer (24%) and colon cancer (16%) among these patients. Clinical data were retrospectively analyzed with respect to the efficacy, safety and outcome of this treatment method. RESULTS Percutaneous antegrade placement of ureteral stents was performed in all cases, including 12 ureters that failed in the initial retrograde ureteral stents placement. The median stent patency time for the antegrade ureteral stents were 10.4 (95% CI: 8.3-12.6) months. The primary complications included mild flank pain and discomfort (44%), hematuria (44%), urinary tract infection (8%), bladder irritation symptoms (4%), and arterial bleeding (4%). CONCLUSION Fluoroscopic guided percutaneous ureteral stents placement is a safe, efficient procedure and has a high success rate in patients with malignant ureteral obstruction.
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Affiliation(s)
- Yang Liu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ketong Wu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyang Lai
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaofei Zeng
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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