Evaluation of metallic stents for malignant ureteral obstruction- a single institution experience

Introduction: Ureteral obstruction caused by extrinsic compression is commonly associated with intra-abdominal malignancy. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. The limitation of polymeric ureteral stents in patients is that they get easily compressed and recurrence of obstruction is seen very quickly. The metallic stents were introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage due to extrinsic malignant obstruction/compression.

Materials and methods: In this study, we described the functional outcomes of a Resonance metallic ureteral stent in patients with malignant ureteral obstruction done during August 2016 till August 2018. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional duration of each stent was calculated.

Results: A total of 27 stents were successfully inserted in 20 patients with malignant ureteral obstruction. After insertion of metallic stents, hydronephrosis subsided or remained stable in 89% of the ureteral units. Serum creatinine decreased or remained stable in 90% of these patients. In 15% ureteric units metallic stents were required to be removed or changed .The Resonance stent exhibited a mean increase in functional response at minimal 1year follow up.

Conclusion: Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications, increased longevity and is well tolerated among patients.

Keywords: Malignant ureteric obstruction; Metallic ureteric stents; Polyurethane DJ stent; PCN

Abbreviations: MUO-Malignant ureteric obstruction; PCN- Per cutaneous nephrostomy; MRI- Magnetic resonance imaging; QOL-Quality of life