Copyright © 2008 Elsevier Inc. All rights reserved.
Endourology/MIS
Malignant Extrinsic Ureteral Obstruction: A Survey of Urologists and Medical Oncologists Regarding Treatment Patterns and Preferences
A total of 157 patients underwent retrograde ureteral stent attempt for malignant extrinsic ureteral obstruction. Mean patient age was 54.7 years (range 23 to 83) and average followup was 13.6 months. Of our patients 61%were women, and the most common cancer diagnoses were ovarian cancer (in 26), lymphoma (17) and cervical cancer (16). A total of 24 patients required immediate percutaneous nephrostomy (PCN) referral. There were 32 patients who experienced a late failure and required PCN (average 180 days after initial stent), and 83 patients in our series (52.9%) who experienced 110 major complications. Type of cancer did not predict need for PCN. However, when invasion into the bladder was noted on cystoscopy, 55.9%(19 of 34, p = 0.008) progressed to PCN referral. A total of 77 patients underwent stent replacement on average 2.8 times and with an interval of 95 days.
In our series patients with malignant extrinsic ureteral compression presenting for ureteral stent(s) experienced a failure rate of 35.7%(56 of 157). Invasion at cystoscopy had a significant predictive value for progression to PCN. We present an algorithm on the management of extrinsic malignant ureteral obstruction.
Cost of malignant ureteral obstruction treated with ure... Journal of the American College of Surgeons |
Cost of malignant ureteral obstruction treated with ureteral stents Journal of the American College of Surgeons, Volume 205, Issue 3, Supplement 1, September 2007, Page S106 Anjali M. Ganatra, Kevin R. Loughlin Purchase PDF (43 K) |
Management of Ureteral Obstruction Due to Advanced Mali... The Journal of Urology |
Management of Ureteral Obstruction Due to Advanced Malignancy: Optimizing Therapeutic and Palliative Outcomes The Journal of Urology, In Press, Corrected Proof, Available online 11 June 2008 Erik Kouba, Eric M. Wallen, Raj S. Pruthi Abstract PurposeTreatment of ureteral obstruction due to advanced abdominal or pelvic malignancy is a clinical challenge. We discuss improvements and modern day outcomes in the palliative treatment of patients with ureteral obstruction by antegrade or retrograde ureteral decompression. Also, potential areas of clinical investigation involving ureteral stent improvement and pharmacological management of relief of symptoms resulting from ureteral obstruction are discussed.Materials and MethodsA literature search was performed using the Entrez-PubMed® database. All relevant literature on ureteral obstruction, advanced malignancy and nephrostomy, ureteral stent and associated topics concerning palliative care and quality of life were reviewed and analyzed. ResultsPresenting symptoms are varied and depend on the acuity of the underlying problem. Mechanisms underlying the pain and symptoms of extrinsic ureteral compression have not fully been explored but they may include prostaglandin and renin-angiotensin pathways with medical interventions potentially directed at such therapeutic targets. Progressive obstructive uropathy may likely lead to clinical manifestations, such as uremia, electrolyte imbalances and persistent urinary tract infections, if obstruction is not bypassed. New approaches to antegrade and retrograde stenting, and the evaluation of new stent materials may help minimize the complications and side effects of such procedures. Unfortunately the finding of ureteral obstruction due to malignancy carries a poor prognosis with a resulting median survival of 3 to 7 months. This prognosis highlights the importance of maintaining quality of life in these patients. ConclusionsPatients presenting with symptoms of ureteral obstruction due to advanced malignancy should be informed of the therapeutic options in the context of the poor prognosis. In the meantime research is needed to find methods of urinary diversion and pharmacological intervention for symptomatic relief without compromising quality of life in patients at the end of life. Purchase PDF (340 K) |
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Malignant Extrinsic Ureteral Obstruction: A Survey of Urologists and Medical Oncologists Regarding Treatment Patterns and Preferences