1
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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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Liu L, Yu C, Sun F, Yang T, Wei D, Wang G, Li S, Liu J. Can preoperative ureteral stents reduce the incidence of ureteral stricture after radiotherapy in patients with cervical cancer? BMC Urol 2022; 22:106. [PMID: 35850859 PMCID: PMC9295481 DOI: 10.1186/s12894-022-01029-0] [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: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To determine the impact of preoperative stent placement on postradiotherapy stricture rate in patients with cervical cancer after radical resection. Methods This study was a retrospective analysis of data collected from 55 cervical cancer patients treated with radiotherapy between June 2016 and June 2020. Patients were divided into the stent and control groups. After 3 months, the stricture rate and the complications related to stent placement between the two groups were compared. Results There were 12 (46.2%) and 10 (34.5%) cases of ureteral stricture in the stent (n = 26) and control (n = 29) groups, respectively, three months after the end of radiotherapy. The incidence rates of ureter stricture in the two groups were not significantly different (P = 0.378). Moreover, there were 20 units (38.5%) and 15 units (25.9%) ureteral strictures in the stent and control groups, respectively. No significant difference in the incidence rates of ureteral strictures was found between the two groups (P = 0.157). There were 13 (50.0%) and 10 (34.5%) cases of ureteral stricture in the stent (n = 26) and control (n = 29) groups, respectively, six months after the end of the radiotherapy. The incidence rates of ureter stricture in the two groups were not significantly different (P = 0.244). Moreover, there were 21 units (40.4%) and 15 units (25.9%) ureteral strictures in the stent and control groups, respectively. No significant difference in the incidence rates of ureteral strictures was found between the two groups (P = 0.105). Complications related to stent placement such as urinary tract infections and bladder irritation were statistically significant (P = 0.006 and P = 0.036) between the two groups; while the other complications were not significantly different (P = 0.070, P = 0.092 and P = 0.586). Conclusions Ureteral stents may not reduce the incidence of ureteral stricture after radiotherapy in patients with cervical cancer. The stent needs to be replaced regularly, and the complications related to stent placement may occur at any time. Thus, preoperative stent placement should be cautious for the clinical management of cervical cancer patients treated with postoperative radiotherapy.
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Affiliation(s)
- Liang Liu
- Department of Urology, Hebei General Hospital, Shijiazhuang, China.,Department of Urology, Baoding NO.1 Central Hospital, Baoding, China
| | - Chunhong Yu
- Department of Medical Examination Center, Hebei General Hospital, Shijiazhuang, China
| | - Fuzhen Sun
- Department of Urology, Hebei General Hospital, Shijiazhuang, China
| | - Tao Yang
- Department of Urology, Hebei General Hospital, Shijiazhuang, China
| | - Dong Wei
- Department of Urology, Hebei General Hospital, Shijiazhuang, China
| | - Gang Wang
- Department of Urology, Hebei General Hospital, Shijiazhuang, China
| | - Shoubin Li
- Department of Urology, Hebei General Hospital, Shijiazhuang, China.
| | - Junjiang Liu
- Department of Urology, Hebei General Hospital, Shijiazhuang, China.
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3
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Kim HJ, Yoon CJ, Lee S, Lee JH, Choi WS, Lee CH. Comparison between antegrade versus retrograde ureteral stent placement for malignant ureter obstruction. J Vasc Interv Radiol 2022; 33:1199-1206. [PMID: 35809804 DOI: 10.1016/j.jvir.2022.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/27/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the technical success of antegrade (AUS) and retrograde ureteral stent placement (RUS) in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS. MATERIALS AND METHODS This study retrospectively included 61 AUS (44 patients) performed under fluoroscopic guidance and 76 RUS (55 patients) under cystoscopic guidance performed in patients with MUO from January 2019 to December 2020. Technical success rates of the two techniques were compared using an inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures. RESULTS Technical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4% [95% CI, 35.4%-63.1%]). Independent predictors for technical failure of the RUS procedure were age ≥ 65 years (OR 5.56, 95% CI 1.73-21.27), ureteral orifice invasion (OR 4.21, 95% CI 1.46-13.46) and extrinsic cancer (OR 15.58, 95% CI 2.92-111.81). CONCLUSIONS The technical success rate of AUS was higher than that of RUS in patients with MUO. RUS failure was associated with age ≥ 65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.
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Affiliation(s)
- Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Seungjae Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chong-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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4
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Kwak J, Cho SB. Fluoroscopy-guided trans-urethral exchange of double-J ureteral stents. BMC Urol 2022; 22:85. [PMID: 35706037 PMCID: PMC9199227 DOI: 10.1186/s12894-022-01034-3] [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: 02/08/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of therapeutic strategies. DJ stents should be replaced at least once every 6 months to avoid infection or obstruction. Although DJ stents are generally replaced under cystoscopy, successful fluoroscopy-guided retrograde replacement of DJ stents in the interventional suite has been described in the literature. Methods Between April 2004 and May 2020, we exchanged 143 DJ stents in 19 male and 22 female patients under fluoroscopic guidance using Nelaton catheters, snare catheters, and 8F DJ stents. All procedures were performed with patients under sedation and local anesthesia. There were 39 patients with malignant ureteral obstruction and two patients with benign ureteral strictures. This study was approved by the Institutional Review Board. Technical success, clinical success, complications, procedure time, and mean interval between two procedures were retrospectively reviewed, and the factors affecting the success rate of the procedure were analyzed. Results Obstruction was detected at the abdominal ureter in 4 patients, pelvic ureter in 29 patients, and intravesical ureter in 8 patients. Twenty-six patients underwent two or more sessions of the procedures, whereas 15 patients underwent single-session procedures. Total 34 outpatient-based procedures and 109 inpatient-based procedures were performed. Technical success and clinical success were achieved in 94.4% (135/143) and 93.3% (126/135) procedures, respectively. Mean procedure time was 21.5 min (range 9–192 min). Mean procedure interval was 101.8 days (range 5–306 days). Technical success was negatively affected by male sex and obstruction at the pelvic ureter and was positively affected by previous successful exchange. Left-sided ureteral stent placement and old age negatively influenced clinical success. Septic shock occurred in one patient and was treated with antibiotics. Conclusion Fluoroscopy-guided trans-urethral exchange of DJ stents is an effective and less painful procedure.
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Affiliation(s)
- JungWon Kwak
- Department of Radiology, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Korea.
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5
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Grubert RM, do Carmo CEF, Morais Neto RS, Tibana TK, Santos RFT, Marchiori E, Nunes TF. Antegrade double-J stenting as an alternative to the retrograde approach: experience of the first 150 cases at a single center in Brazil. Radiol Bras 2021; 54:353-359. [PMID: 34866694 PMCID: PMC8630954 DOI: 10.1590/0100-3984.2020.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To present our clinical experience with percutaneous antegrade ureteral
stenting. Materials and Methods This was a single-center retrospective study in which we reviewed the
electronic medical records of patients who underwent percutaneous
image-guided antegrade ureteral stenting between January 2016 and August
2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15
years (range, 30-94 years). Patients were divided into two main groups:
those with malignant neoplasms; and those with non-neoplastic disease.
Technical and clinical success of the procedure were defined, respectively,
as maintenance of the patency of the urinary tract, with a reduction in the
degree of hydronephrosis, and as a reduction in the level of nitrogenous
waste. Postprocedural complications were categorized as major or minor
according to the CIRSE classification. Results The study sample comprised 150 antegrade stenting procedures performed in 90
patients, most of whom had previously undergone retrograde stenting that was
unsuccessful. The stenting was bilateral in 60 patients and unilateral in
30. Technical success was achieved in 143 (95.3%) of the procedures, whereas
seven procedures (4.6%) were unsuccessful. Failed procedures were
characterized by inability to place a stent or migration of a stent after
its placement. Complications occurred in 12 (8.0%) of the procedures. Of
those 12 complications, two were classified as major (bleeding) and 10 were
classified as minor (lumbar pain or infection). The most common techniques
used were the over-the-wire technique and the modified technique (in 58.0%
and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy
tube was inserted. Conclusion Percutaneous antegrade ureteral stenting is a safe, effective method for the
management of ureteral injuries and obstructions, due to malignant or benign
causes, when the retrograde approach has failed.
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Affiliation(s)
- Renata Motta Grubert
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Carlos Egydio Ferri do Carmo
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Reinaldo Santos Morais Neto
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Rômulo Florêncio Tristão Santos
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
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6
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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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7
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Tlili G, Ammar H, Dziri S, Ben Ahmed K, Farhat W, Arem S, Acacha E, Gupta R, Rguez A, Jaidane M. Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study. Ann Med Surg (Lond) 2021; 69:102726. [PMID: 34466220 PMCID: PMC8382984 DOI: 10.1016/j.amsu.2021.102726] [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: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Ureteral double- J stent is usually inserted by retrograde approach to treating obstructed upper urinary tract. The antegrade approach, can be suitable alternative in certain situations without general or spinal anesthesia. The present study demonstrates the indications, success rate, and complications of this approach in treatmenting malignant obstructive uropathy. Methods Data of consecutive patients with malignant obstructive uropathy who underwent antegrade ureteral stenting in the Department of Interventional Radiology at Sahloul hospital from January 2013 to February 2020 was retrieved and retrospectively analyzed. Result A total of 188 attempts of antegrade ureteral stent insertion was performed during the study period (left side = 78, right side = 82, bilateral = 14). The mean age was 54 years (range: 9–91 years). The indication of the antegrade stenting was the failure of retrograde approach in 63 patients.The single-stage approach was performed 103 times. A percutaneous nephrostomy was placed for the average duration of 22.4 days (range: 2–60 days) for subsequent attempts. Only four patients required general anesthesia. Ureteral obstruction was caused by bladder cancer (n = 92), uterine cancer (n = 31), prostate cancer (n = 28), colorectal cancer (n = 15) and retroperitoneal tumor (n = 8). A protective nephrostomy was left in situ in 44 cases for 48 h. Clinical success was achieved in 96% of the cases. Two and three patients required hospitalization for perirenal abscess and hematuria, respectively. Conclusion This retrospective study shows that antegrade ureteral stent insertion has a high success rate with minimal complications. Trial registration ClinicalTrials.gov Identifier: NCT04649970. Registered december 2, 2020- Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT04649970; Ureters are easily affected by malignant conditions resulting in the interruption of urinary drainage. Double J (JJ) stents placement is the most common method for relieving urinary obstruction in such cases. The percutaneous antegrade ureteral stenting (PAUS) technique is a relatively newer technique for ureteral stenting. PAUS can be used as an alternative route for relieving ureteral obstruction due to malignancies.
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Affiliation(s)
- Ghassen Tlili
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sonia Dziri
- Department of Nephrology, Sahloul Hospital, Sousse, Tunisia
| | | | - Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sofiene Arem
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Emir Acacha
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Arib Rguez
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mehdi Jaidane
- Department of Urology, Sahloul Hospital, Sousse, Tunisia
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Ohtaka M, Kawahara T, Hayashi Y, Kobayashi R, Tsutsumi S, Ousaka K, Takizawa A, Kishida T, Yao M, Uemura H. Use of metallic and polymeric ureteral stents in malignant ureteral obstruction. BJUI COMPASS 2021; 2:58-63. [PMID: 35474665 PMCID: PMC8988829 DOI: 10.1002/bco2.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 11/11/2022] Open
Abstract
Background Malignant ureteral obstruction (MUO) is often caused by advanced intra‐abdominal cancers. Effective management must be attempted, but the treatment policy is unclear. Metallic ureteral stents are one of the latest options in managing MUO. Metallic ureteral stents are superior to traditional polyurethane stents. The present study retrospectively reviewed our four institutions’ experiences with treating MUO using metallic ureteral stent. Methods A total of 45 patients who required metallic ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, JAPAN) between January 2014 and May 2016 were analyzed. We defined stent failure as having to change the ureteral stent before the scheduled ureteral stent exchange time or having to perform percutaneous nephrostomy (PCN). Complications were defined as an unscheduled hospital visit or hospitalization caused by incompatibility, infection, and pain of the metallic ureteral stent, etc., unrelated to the primary disease. We compared stent failure and the overall survival (OS) between metallic and polymeric ureteral stents. To evaluate the workload of the medical staff, we used the NASA Task Load Index (NASA‐TLX) in a total of 11 urologists. Results During the observation period, 8 (17.8%) patients in the metallic ureteral stent group and 10 (27.8%) in the control group developed stent failure. Complications were noted in 14 (31.1%) patients in the metallic ureteral stent group and 15 (41.7%) patients in the control group. A Kaplan–Meier analysis and log‐rank test showed no significant differences between two groups in the overall survival (P = 0.673). One or more complications developed in 19 (32.2%) patients in the metallic ureteral stent group and 18 (38.3%) patients in the control group (P = 0.409). Renal dysfunction after the replacement of the ureteral stent developed in 9 (15.3%) patients in the metallic ureteral stent group and 14 (29.8%) patients in the control group. No patients developed a urinary tract infection (UTI) that required hospitalization in the metallic ureteral stent group, whereas 3 (6.4%) patients in the control group had a UTI that was treated with hospitalization. The average workload score in the six subscales was analyzed, and the scores for mental demand and performance were higher in the metallic ureteral stent group, although there was no significant difference between the metallic and polymeric ureteral stent groups. Conclusions Metallic ureteral stents showed favorable ureteral stent patency and reduced the workload for urologists.
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Affiliation(s)
- Mari Ohtaka
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Yutaro Hayashi
- Department of Urology International Goodwill Hospital Yokohama Japan
| | - Ryosuke Kobayashi
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Sohgo Tsutsumi
- Department of Urology Kanagawa Cancer Center Yokohama Japan
| | - Kimito Ousaka
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Akitoshi Takizawa
- Department of Urology International Goodwill Hospital Yokohama Japan
| | | | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
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9
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Guachetá-Bomba PL, Echeverría-García F, García-Perdomo HA. Predictors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction: systematic review and meta-analysis. BJU Int 2020; 127:292-299. [PMID: 32916038 DOI: 10.1111/bju.15237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction. METHODS We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries). RESULTS We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I2 = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I2 = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I2 = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I2 = 0%). CONCLUSIONS We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.
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Affiliation(s)
- Pedro Luis Guachetá-Bomba
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | - Fernando Echeverría-García
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | - Herney Andrés García-Perdomo
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
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10
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Maybody M, Shay WK, Fleischer DA, Hsu M, Moskowitz C. Estimation of successful capping with complete aspiration of bladder via nephroureterostomy tube. World J Clin Urol 2020; 9:1-8. [PMID: 33235829 PMCID: PMC7682400 DOI: 10.5410/wjcu.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/16/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ureteral stent and nephroureterostomy tube (NUT) are treatments of ureteral obstruction. Ureteral stent provides better quality of life. Internalization of NUT is desired whenever possible.
AIM To assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder via NUT.
METHODS Our Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 (n = 578). Cases were excluded due to lack of imaging of bladder (n = 37), incomplete aspiration of bladder (n = 324), no attempt at capping NUT (n = 166), and patients with confounding factors interfering with results of capping trial including non-compliant bladder, bladder outlet obstruction and catheter malposition (n = 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) most with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn’s disease. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated.
RESULTS Among patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 0.65-0.92) catheters were successfully capped (range 12-94 d, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Seven capping trials (19%, 95%CI: 0.08-0.35) were unsuccessful (range 2-22 d, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/vomiting (1).
CONCLUSION Capping trial success among patients with complete aspiration of retained contrast/urine from bladder via NUT appears high.
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Affiliation(s)
- Majid Maybody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Wesley K Shay
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Deborah A Fleischer
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Meier Hsu
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Chaya Moskowitz
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Matsuura H, Arase S, Hori Y. Clinical outcomes and prognostic factors associated with internal ureteral stent placement for malignant extrinsic ureteral obstruction. Support Care Cancer 2020; 28:5743-5750. [PMID: 32206969 DOI: 10.1007/s00520-020-05413-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The optimal management of malignant extrinsic ureteral obstruction (MUO) remains unclear. It is necessary to assess the patient prognosis in deciding the adaptation of drainage of renal pelvis. In this study, we investigated the clinical outcomes after ureteral stenting for MUO and the predictive factors for overall survival in order to create a risk-stratification model. METHODS We retrospectively analyzed the clinical and laboratory data of 93 patients with radiologically significant hydronephrosis associated with MUO who underwent successful stent placement between May 2005 and May 2018. RESULTS The median survival duration after the initial stent insertion was 266 days. Of the 93 patients, 70 died, and the median interval from the first stent insertion to death was 160 days. Multivariate analysis showed that gastric cancer as the primary disease, poor performance status before stenting, and treatment after stent insertion were significant predictors of survival. According to these three factors, we stratified patients into the following four prognostic groups: no-factor (43 patients), one-factor (23 patients), two-factor (23 patients), and three-factor (4 patients) groups. This classification was effective for predicting survival, and the median survival durations in these groups were 807, 269, 44, and 12 days, respectively (p < 0.001). CONCLUSIONS Our stratification model of patients with a poor prognosis after ureteral stent placement for MUO may allow urologists and clinicians to identify patients who will benefit from ureteral stenting.
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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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12
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Turgut B, Bayraktar AM, Bakdık S, Hamarat MB, Öncü F, Gönen M, Tolu I. Placement of double-J stent in patients with malignant ureteral obstruction: antegrade or retrograde approach? Clin Radiol 2019; 74:976.e11-976.e17. [PMID: 31506172 DOI: 10.1016/j.crad.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/14/2019] [Indexed: 12/30/2022]
Abstract
AIM To determine whether antegrade or retrograde methods should be preferred for double-J stent placement in patients with malignant ureteral obstruction (MUO). MATERIAL AND METHODS The medical records of patients treated for MUO in the Urology and Interventional Radiology Clinic, Konya Training and Research Hospital, were reviewed retrospectively. Patients with benign aetiology were excluded from the study. Reports of the procedures, ultrasonography findings, computed tomography (CT), angiography, and pyelography images and the follow-up records of patients with MUO were assessed. A total of 111 patients and 114 ureteral stenting treatments were included in the study; 63 (55.3%) were operated on using the antegrade ureteral stenting (AUS) method, whereas 51 (44.7%) were operated on using the retrograde ureteral stenting (RUS), method, and the characteristics of these groups were evaluated. The presence of hydroureteronephrosis and ureteral tortuosity were determined. RESULTS Overall success rates were found to be 95.2% using the AUS method and 47.1% using the RUS method. The technical success of the antegrade method was significantly higher in patients with or without tortuosity (respectively: p=0.005, Z shape p=0.001, pigtail shape p=0.035″). The technical success of the antegrade method was significantly higher in patients with hydroureteronephrosis (p=0.001). CONCLUSION The AUS technique should be the first choice for double-J stent placement in patients with MUO.
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Affiliation(s)
- B Turgut
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey.
| | - A M Bayraktar
- Department of Urology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - S Bakdık
- Department of Radiology, University of Necmettin Erbakan Training and Research Hospital, Konya, Turkey
| | - M B Hamarat
- Department of Urology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - F Öncü
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - M Gönen
- Department of Urology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - I Tolu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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13
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Kahriman G, Özcan N, Doğan A, İmamoğlu H, Demirtaş A. Percutaneous antegrade ureteral stent placement: single center experience. ACTA ACUST UNITED AC 2019; 25:127-133. [PMID: 30860076 DOI: 10.5152/dir.2019.18252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to present our clinical experience with percutaneous antegrade ureteral stent placement in a single center. METHODS Electronic records of patients who underwent percutaneous image-guided ureteral stent placement between September 2005 and April 2017 were reviewed. A total of 461 patients (322 males, 139 females; age range, 19-94 years; mean age, 61.4±15 years) were included in the study. Patients were classified into two main groups: those with neoplastic disease and those with non-neoplastic disease. Failure was defined as persistence of high level of serum creatinine or an inability to place stents percutaneously. Postprocedural complications were grouped as percutaneous nephrostomy and stent placement related complications. RESULTS A total of 727 procedures in 461 patients were included in the study: 654 procedures (90%) in 407 patients (88.3%) were in the neoplastic group and 73 procedures (10%) in 54 patients (11.7%) were in the non-neoplastic group. Our technical success rates were 97.7% and 100% and complication rates were 3.1% and 4.1% in neoplastic and non-neoplastic groups, respectively. Seven stents retrievals and 112 balloon dilatations were performed successfully. CONCLUSION Percutaneous antegrade ureteral stent placement is a safe and effective method for management of ureteral injuries and obstructions due to both malignant and benign causes when the retrograde approach has failed.
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Affiliation(s)
- Güven Kahriman
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Özcan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Aytaç Doğan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Hakan İmamoğlu
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Abdullah Demirtaş
- Departments of Urology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
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14
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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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15
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Ohtaka M, Kawahara T, Takamoto D, Mochizuki T, Hattori Y, Teranishi JI, Makiyama K, Miyoshi Y, Yumura Y, Yao M, Uemura H. Gastrointestinal cancer and bilateral hydronephrosis resulted in a high risk of ureteral stent failure. BMC Urol 2018; 18:35. [PMID: 29739370 PMCID: PMC5941491 DOI: 10.1186/s12894-018-0346-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 04/26/2018] [Indexed: 12/14/2022] Open
Abstract
Background Urologists frequently encounter malignant ureteral obstruction (MUO) caused by advanced urological or non-urological malignant disease, but the treatment policy is unclear. The present study examined the risk factors for predicting ureteral stent failure in patients with MUO after ureteral stent insertion and the change in the renal function after retrograde ureteral stent insertion in cases of bilateral hydronephrosis. Methods A total of 39 patients who required ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, Japan) between February 2007 and May 2016 were included in this study. The age, gender, type of cancer, hydronephrosis side, pre-stenting estimated glomerular filtration rate (eGFR), and eGFR increase were assessed as predictive factors for stent failure. Among these 39 patients, 25 showed bilateral hydronephrosis. Thirteen of these patients had bilateral ureteral stents placed, and the remaining 12 had a unilateral ureteral stent placed. The renal function and overall survival (OS) were analyzed between these two groups. Results Among all 39 patients, 9 (23.1%) had stent failure. A univariate analysis revealed that causative disease (gastrointestinal cancer vs. others; p = 0.045) and laterality of hydronephrosis (bilateral vs. unilateral; p = 0.05) were associated with stent failure. A multivariate analysis revealed that only age (hazard ratio, 0.938; 95% confidence interval, 0.883–0.996; p = 0.038) was associated with stent failure. A Kaplan-Meier analysis and log-rank test indicated that having a unilateral ureteral stent placed was not correlated with a lower OS rate than having bilateral ureteral stents placed (p = 0.563). Among patients with bilateral hydronephrosis, the increase in the eGFR of those who had bilateral ureteral stents placed was not significantly different from that of those who had a unilateral ureteral stent placed (p = 0.152). Conclusions We revealed that age > 60 years was helpful for predicting stent failure. MUO due to gastrointestinal cancer and bilateral hydronephrosis may be predictive of stent failure. These factors may help urologists decide the optimal time to perform early percutaneous nephrostomy. These findings suggest that patients with bilateral hydronephrosis do not necessarily need to have a ureteral stent placed into both sides of the hydronephrosis.
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Affiliation(s)
- Mari Ohtaka
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan. .,Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Taku Mochizuki
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yusuke Hattori
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Jun-Ichi Teranishi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yasushi Yumura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, 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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Zhou J, Xiang W, Li S, Hu Q, Peng T, Chen L, Ming Y. Association between long non-coding RNAs expression and pathogenesis and progression of gliomas. Oncol Lett 2018. [PMID: 29541171 PMCID: PMC5835862 DOI: 10.3892/ol.2018.7875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The incidence rate of gliomas is the highest among primary brain tumors. Although the understanding of the molecular pathology of glioma has improved during the previous two decades, effective therapies are not yet available to treat these tumors. Previous studies have indicated that long non-coding RNAs (lncRNAs) have a close association with glioma, suggesting that lncRNAs may be potential targets for the development of novel treatments for glioma. The present review summarized the latest studies on the dysregulation of lncRNAs in glioma, and discussed their potential use in the diagnosis, prognosis and therapies of glioma. The emergence of lncRNAs has revealed an additional facet to glioma oncogenesis. An improved understanding of their functions is important to advance lncRNA-based diagnosis, prognosis and therapeutic interventions of glioma.
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Affiliation(s)
- Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Qi Hu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Tao Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yang Ming
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Kim SH, Park B, Joo J, Joung JY, Seo HK, Chung J, Lee KH. Retrograde pyelography predicts retrograde ureteral stenting failure and reduces unnecessary stenting trials in patients with advanced non-urological malignant ureteral obstruction. PLoS One 2017; 12:e0184965. [PMID: 28931043 PMCID: PMC5607161 DOI: 10.1371/journal.pone.0184965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 09/04/2017] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate predictive factors for retrograde ureteral stent failure in patients with non-urological malignant ureteral obstruction. Materials and methods Between 2005 and 2014, medical records of 284 malignant ureteral obstruction patients with 712 retrograde ureteral stent trials including 63 (22.2%) having bilateral malignant ureteral obstruction were retrospectively reviewed. Retrograde ureteral stent failure was defined as the inability to place ureteral stents by cystoscopy, recurrent stent obstruction within one month, or non-relief of azotemia within one week from the prior retrograde ureteral stent. The clinicopathological parameters and first retrograde pyelographic findings were analyzed to investigate the predictive factors for retrograde ureteral stent failure and conversion to percutaneous nephrostomy in multivariate analysis with a statistical significance of p < 0.05. Results Retrograde ureteral stent failure was detected in 14.1% of patients. The mean number of retrograde ureteral stent placements and indwelling duration of the ureteral stents were 2.5 ± 2.6 times and 8.6 ± 4.0 months, respectively. Multivariate analyses identified several specific RGP findings as significant predictive factors for retrograde ureteral stent failure (p < 0.05). The significant retrograde pyelographic findings included grade 4 hydronephrosis (hazard ratio 4.10, 95% confidence interval 1.39–12.09), irreversible ureteral kinking (hazard ratio 2.72, confidence interval 1.03–7.18), presence of bladder invasion (hazard ratio 4.78, confidence interval 1.81–12.63), and multiple lesions of ureteral stricture (hazard ratio 3.46, confidence interval 1.35–8.83) (p < 0.05). Conclusion Retrograde pyelography might prevent unnecessary and ineffective retrograde ureteral stent trials in patients with advanced non-urological malignant ureteral obstruction.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Kyung Seo
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jinsoo Chung
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Kang Hyun Lee
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
- * E-mail:
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