Gastric cancer with obstructive uropathy: clinical experience with 17 cases.
BACKGROUND
Gastric cancer can spread to either the paraaortic area or pelvis causing ureteral obstruction.


METHODS
Between 1984 and 1996, 17 patients with gastric cancer were proven to have obstructive uropathy (OU). Of these, 12 (70%) had poorly differentiated adenocarcinomas.


RESULTS
The obstructed levels were at the proximal ureter (7 cases), distal ureter (7 cases), and at multiple sites in the ureter (3 cases). The mucosa of the ureter tended to be spared. In 3 cases, OU was the initial presentation. Peritoneal carcinomatosis was noted in all cases. Most cases demonstrated obvious paraaortic lymph node and/or pelvic metastases. Management of ureteral obstruction included percutaneous nephrostomy (PCN) in 8 cases, and cystoscopic placement of a ureteral stent in 9 cases with double-J stents used in 8. Insertion of the double-J stent failed in 1 case initially. Four cases using double-J stents resulted in occlusion within 1 month, of which 3 subsequently were successfully changed to PCN.


CONCLUSIONS
Gastric cancer with OU can obstruct the ureter at any level. Double-J stents exhibited a high failure rate in these patients necessitating a switch to PCN. We could also choose PCN as the initial procedure to preserve renal function.
Liaw
C C
CC
Department of Internal Medicine, Chang-Gung Memorial Hospital, Taipei.
Chuang
C K
CK
Chen
J S
JS
Chang
H K
HK
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*