Mp42-09 failure of tandem ureteral stents for malignant ureteral obstruction- what's next?

You have accessJournal of UrologyCME1 Apr 2023MP42-09 FAILURE OF TANDEM URETERAL STENTS FOR MALIGNANT URETERAL OBSTRUCTION- WHAT'S NEXT? Orel Carmona, Asaf Shvero, Dorit E. Zilberman, Zohar A. Dotan, and Nir Kleinmann Orel CarmonaOrel Carmona More articles by this author , Asaf ShveroAsaf Shvero More articles by this author , Dorit E. ZilbermanDorit E. Zilberman More articles by this author , Zohar A. DotanZohar A. Dotan More articles by this author , and Nir KleinmannNir Kleinmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The success rate of drainage with tandem ureteral stents (TUS) for malignant ureteral obstruction (MUO) is 72-87%. Failure of TUS is usually followed by the insertion of a percutaneous nephrostomy tube (PCN). The objective of this study was to examine the possibility of replacing the first-time failed TUS with a new pair of TUS- the success rate of the procedure, and the risk factors for a second failure. METHODS: The medical records of all patients with MUO who underwent balloon dilation and TUS insertion in our institution between 2014-2022 were retrospectively analyzed. Failure of TUS was defined as an episode of urosepsis, recurrent urinary tract infections, acute kidney failure, or detection of new hydronephrosis on imaging scans. Independent risk predictors of failure of secondary TUS were determined by a multivariate cox regression analysis. RESULTS: 240 procedures were performed on 186 patients during the study period. 67 (36%) patients failed for the first time after a median follow-up time of 7 months (IQR 4-17). Of which, 25 (37.4%) patients were drained by a PCN, and 42 (62.6%) were treated by exchanging the TUS with a new pair. Among the patients who underwent a second TUS insertion, 18 (42.8%) did not fail again, and continued to enjoy timely replacements of the TUS. However, 24 (57.2%) patients did fail for the second time and were drained via PCN. In a multivariant analysis, we found that inserting the same diameter TUS as the pair that failed (p=0.002) and time to first failure ≤6 months (p=0.006) were significant risk factors for a second failure of TUS. Cox regression analysis found that distal ureteral stricture predicts shorter time to second failure. During the study period, the group that didn’t fail for a second time underwent 73 replacements of TUS overall (4±2.3 procedures per patient) in a median follow-up time of 19.5 months. CONCLUSIONS: The success rate of replacing TUS after its failure is 42.8%. When replacing failed TUS, one should consider larger-diameter stents. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e570 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Orel Carmona More articles by this author Asaf Shvero More articles by this author Dorit E. Zilberman More articles by this author Zohar A. Dotan More articles by this author Nir Kleinmann More articles by this author Expand All Advertisement PDF downloadLoading ...