Placement of metallic stents in ureters obstructed by carcinoma of the cervix to maintain renal function in patients undergoing long-term chemotherapy.
OBJECTIVE
Metallic stents, sometimes augmented by "J" endostents, were placed in ureters obstructed by advanced carcinoma of the cervix to improve or maintain renal function in these patients at a level necessary to pursue long-term chemotherapy and radiation therapy.


METHODS
Seventeen ureters in 11 patients were treated with metallic stents, which were placed by an anterograde approach in 10 patients and by a retrograde approach in one. An anterograde ureteroneocystostomy was necessary in two of the 11 patients. J endostents were placed for I month in all patients. In 10 ureters, J endostents were reintroduced during follow-up 1-48 months later.


RESULTS
In 17 ureters, metallic stents were successfully placed; in the remaining three ureters, the procedures were aborted because of technical difficulties. The goal of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabilized at a range of 2.7-3.2 mg/dl in six more patients, permitting treatment with chemotherapy, radiation therapy, or both. Four of the 11 patients died within 4 months after treatment, and three more died within 2 years. At the time of death or last follow-up, seven metallic stents and eight combinations of metallic stents and J endostents were patent. Complications were minor.


CONCLUSIONS
Placement of metallic stents is recommended as an effective method to ensure patency and to facilitate cystoscopic replacement of J endostents in ureters compromised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy. Survival is governed by the effectiveness of chemotherapy and radiation therapy.
Lang
E K
EK
Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103-2714, USA.
Irwin
R J
RJ
Lopez-Martinez
R A
RA
LaNasa
J
J
Kasabian
N
N
Watson
R A
RA
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D014513:Ureter; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000628:therapy
D000970:Antineoplastic Agents; D003404:Creatinine