Predictor for Ureteral Stent Removal in Gynecological Cancer Patients with a Ureteral Obstruction
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Purpose: This study investigated the possibility of ureteral stent removal in patients with gynecological cancer and ureteral obstruction. Materials and Methods: From February 2010 to March 2022, the records of 121 patients with gynecological cancer and ureteral obstruction undergoing periodic ureteral stent replacement were reviewed retrospectively. Ureteral stent removal was attempted in patients who showed improvement in hydronephrosis on abdominal computed tomography (CT) after ureteral stent insertion and who lost symptoms. Success was defined as not having to reinsert the stent because there were no uncomfortable symptoms. The following were evaluated as predictors for ureteral stent removal: pre-removal serum creatinine, hypertension, diabetes, asymptomatic bacteriuria, type of gynecologic malignancy, prior radiotherapy, hydronephrosis laterality, obstruction level, hydronephrosis etiology, ureteral stent size, and ureteral stent duration. The hydronephrosis changes on abdominal CT were also evaluated. Results: Among 121 patients, 74 with 81 obstructed ureters were evaluated. Of the 81 ureters, successful removal occurred in 30 (37.0%). There were significant differences between the success and failure cases regarding asymptomatic bacteriuria, prior radiotherapy, and hydronephrosis etiology. Logistic regression analysis showed that asymptomatic bacteriuria and hydronephrosis etiology were significant predictors of ureteral stent removal (p<0.05). There were also significant differences in the hydronephrosis changes depending on asymptomatic bacteriuria and hydronephrosis etiology (p<0.05). Conclusions: In patients with gynecological cancer who have a ureteral stent in place due to ureteral obstruction, ureteral stent removal may be considered in patients who do not have asymptomatic bacteriuria or other etiologies, such as external ureteral pressure or ureteral cancer metastasis.
Abstract
Purpose: This study investigated the possibility of ureteral stent removal in patients with gynecological cancer and ureteral obstruction. Materials and Methods: From February 2010 to March 2022, the records of 121 patients with gynecological cancer and ureteral obstruction undergoing periodic ureteral stent replacement were reviewed retrospectively. Ureteral stent removal was attempted in patients who showed improvement in hydronephrosis on abdominal computed tomography (CT) after ureteral stent insertion and who lost symptoms. Success was defined as not having to reinsert the stent because there were no uncomfortable symptoms. The following were evaluated as predictors for ureteral stent removal: pre-removal serum creatinine, hypertension, diabetes, asymptomatic bacteriuria, type of gynecologic malignancy, prior radiotherapy, hydronephrosis laterality, obstruction level, hydronephrosis etiology, ureteral stent size, and ureteral stent duration. The hydronephrosis changes on abdominal CT were also evaluated. Results: Among 121 patients, 74 with 81 obstructed ureters were evaluated. Of the 81 ureters, successful removal occurred in 30 (37.0%). There were significant differences between the success and failure cases regarding asymptomatic bacteriuria, prior radiotherapy, and hydronephrosis etiology. Logistic regression analysis showed that asymptomatic bacteriuria and hydronephrosis etiology were significant predictors of ureteral stent removal (p<0.05). There were also significant differences in the hydronephrosis changes depending on asymptomatic bacteriuria and hydronephrosis etiology (p<0.05). Conclusions: In patients with gynecological cancer who have a ureteral stent in place due to ureteral obstruction, ureteral stent removal may be considered in patients who do not have asymptomatic bacteriuria or other etiologies, such as external ureteral pressure or ureteral cancer metastasis.
참고문헌 (17)
- Ganatra AM, "The management of malignant ureteral obstruction treated with ureteral stents", J Urol, 174, pp.2125~2128 (2005)
- Sountoulides P, "Endourologic management of malignant ureteral obstruction : indications, results, and quality-of-life issues", J Endourol, 24, pp.129~142 (2010)
- Chung SY, "15-Year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents", J Urol, 172, pp.592~595 (2004)
- Izumi K, "Current outcome of patients with ureteral stents for the management of malignant ureteral obstruction", J Urol, 185, pp.556~561 (2011)
- Wang JY, "Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients", Oncol Lett, 11, pp.879~883 (2016)
- Kurata S, "Outcomes of ureteral stent placement for hydronephrosis in patients with gynecological malignancies", Curr Urol, 10, pp.126~131 (2017)
- Glodny B, "Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract : a 64-slice multidetector CT study in 1072 patients with 2132kidneys", Br J Radiol, 84, pp.145~152 (2011)
- An T, "Ureteral cancer : complete ureteral obstruction on computed tomography urography is associated with periureteral fat invasion", Eur J Radiol, 130, pp.109198~ (2020)
- Cox CE, "Experiments with induced bacteriuria, vesical emptying and bacterial growth on the mechanism of bladder defense to infection", J Urol, 86, pp.739~748 (1961)
- Heyns CF, "Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder", World J Urol, 30, pp.77~83 (2012)
- Vallée M, "Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients : a systematic review of the literature", World J Urol, 39, pp.3845~3860 (2021)
- 유성현, "Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents", Investigative and Clinical Urology, 54(5), pp.316~321 (2013), 대한비뇨의학회
- Yeaman CT, "Impact of radiation on the incidence and management of ureteroenteric strictures : a contemporary single center analysis", BMC Urol, 21, pp.101~ (2021)
- Horan G, "Pelvic radiotherapy in patients with hydronephrosis in stage IIIB cancer of the cervix : renal effects and the optimal timing for urinary diversion", Gynecol Oncol, 101, pp.441~444 (2006)
- Höckel M, "Surgical treatment and histopathological assessment of advanced cervicovaginal carcinoma : a prospective study and retrospective analysis", Eur J Cancer, 70, pp.99~110 (2017)
- Joshi HB, "Ureteral stent symptom questionnaire : development and validation of a multidimensional quality of life measure", J Urol, 169, pp.1060~1064 (2003)
- Joshi HB, "Indwelling ureteral stents : evaluation of quality of life to aid outcome analysis", J Endourol, 15, pp.151~154 (2001)