Ureteral stent insertion failure in obstructive uropathy secondary to cervical cancer
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v83i2.1017Keywords:
Cervical Cancer, malignant ureteral obstruction , ureteral catheterization, acute kidney failure, pelvic neoplasmsAbstract
Introduction: To identify preoperative features that predict ureteral stent placement failure in women with obstructive uropathy secondary to cervical cancer.
Methods: Observational, descriptive, analytical study. Clinical registries of patients with diagnosis of obstructive uropathy secondary to cervical cancer were reviewed. Fifty-two patients attended between January 2017 to January 2021 were included. Diagnosis of obstructive uropathy consisted of hydronephrosis or hydroureter in imaging studies and elevation in baseline serum creatinine and blood urea nitrogen with uremic syndrome. An analysis of variables of interest was carried out to assess the association with ureteral stent placement failure.
Results: We observed that the overall rate of failed ureteral stent placement was 55.8%. We did not find any differences in baseline characteristics between patients with successful or unsuccessful ureteral stent placement. A higher percentage of patients with failed urinary diversion on admission had a decrease in urinary output (58.6% vs. 30.4%, p=0.04), uremic syndrome (51.7% vs. 21.7%, p=0.02), as well as an increased median serum creatinine (6.6 vs. 2.6 mg/dL, p=0.03) compared to patients with successful ureteral stent placement. An admission serum creatinine cut-off value of 3.4 mg/dL yielded sensitivity of 69% and specificity of 65.2% for unsuccessful ureteral stent placement (AUC=0.674, 95% CI 0-52-0.82; p=0.03).
Conclusion: Our data suggest that distal ureteral obstruction evidenced by imaging, regardless of the extent of invasion, is the most important factor related to unsuccessful ureteral stent placement.
References
Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet. 2019;145(1):129–35. doi: https://doi.org/10.1002/ijgo.12749
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: https://doi.org/10.3322/caac.21492
Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021;149(4):778–89. doi: https://doi.org/10.1002/ijc.33588
Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1–17. doi: https://doi.org/10.1128/CMR.16.1.1-17.2003
Chitale SV, Scott-Barrett S, Ho ETS, Burgess NA. The Management of Ureteric Obstruction Secondary to Malignant Pelvic Disease. Clinical Radiology. 2002;57(12):1118–21. doi: https://doi.org/10.1053/crad.2002.1114
Ganatra AM, Loughlin KR. The Management of Malignant Ureteral Obstruction Treated with Ureteral Stents. Journal of Urology. 2005;174(6):2125–8. doi: https://doi.org/10.1097/01.ju.0000181807.56114.b7
Goldfarb RA, Fan Y, Jarosek S, Elliott SP, University of Minnesota, USA. The burden of chronic ureteral stenting in cervical cancer survivors. Int braz j urol. 2017;43(1):104–11. doi: https://doi.org/10.1590/s1677-5538.ibju.2016.0667
Guan P, Howell-Jones R, Li N, Bruni L, De Sanjosé S, Franceschi S, et al. Human papillomavirus types in 115,789 HPV-positive women: A meta-analysis from cervical infection to cancer. Int J Cancer. 2012;131(10):2349–59. doi: https://doi.org/10.1002/ijc.27485
Humphreys BD, Soiffer RJ, Magee CC. Renal Failure Associated with Cancer and Its Treatment: An Update. Journal of the American Society of Nephrology. 2005 Jan;16(1):151–61. doi: https://doi.org/10.1681/asn.2004100843
Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure. Int J Clin Oncol. 2019;24(3):306–12. doi: https://doi.org/10.1007/s10147-018-1348-6
Maguire PJ, Sobota A, Mulholland D, Ryan JM, Gleeson N. Incidence, management, and sequelae of ureteric obstruction in women with cervical cancer. Support Care Cancer. 2020;28(2):725–30. doi: https://doi.org/10.1007/s00520-019-04851-9
McCullough TC, May NR, Metro MJ, Ginsberg PC, Jaffe JS, Harkaway RC. Serum creatinine predicts success in retrograde ureteral stent placement in patients with pelvic malignancies. Urology. 2008;72(2):370–3. doi: https://doi.org/10.1016/j.urology.2007.12.068
Pradhan TS, Duan H, Katsoulakis E, Salame G, Lee Y-C, Abulafia O. Hydronephrosis as a Prognostic Indicator of Survival in Advanced Cervix Cancer: International Journal of Gynecological Cancer. 2011;21(6):1091–6. doi: https://doi.org/10.1097/igc.0b013e31821cabc8
Radecka E, Magnusson M, Magnusson A. Survival time and period of catheterization in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy. Acta Radiol. 2006;47(3):328–31. doi: https://doi.org/10.1080/02841850500492092
Song Y, Fei X, Song Y. Percutaneous Nephrostomy Versus Indwelling Ureteral Stent in the Management of Gynecological Malignancies: International Journal of Gynecological Cancer. 2012;22(4):697–702. doi: http://dx.doi.org/10.1097/IGC.0b013e318243b475
Tan S, Tao Z, Bian X, Zhao Y, Wang N, Chen X, et al. Ureteral stent placement and percutaneous nephrostomy in the management of hydronephrosis secondary to cervical cancer. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019;241:99–103. doi: https://doi.org/10.1016/j.ejogrb.2019.08.020
Uthappa MC, Cowan NC. Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction? Clin Radiol. 2005;60(5):608–12. doi: https://doi.org/10.1016/j.crad.2004.11.014
Wang J-Y, Zhang H-L, Zhu Y, Qin X-J, Dai B, Ye D-W. Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients. Oncology Letters. 2016;11(1):879–83. doi: https://doi.org/10.3892/ol.2015.3961
