title: Stent-change therapy in advanced malignancies with ureteral obstruction.
abstract: OBJECTIVE
  To determine if patients with advanced malignancies and resultant ureteral obstruction who are managed with chronic ureteral stent changes have adequate preservation of renal function and an acceptable rate of complications.
  
  
  METHODS
  A retrospective review was conducted on 28 patients who had a stent to relieve ureteral obstruction caused by cancer.
  
  
  RESULTS
  During the study period, 201 stents were placed, a median of 4 (range 1-34) per patient. The mean time from cancer diagnosis to first stent placement was 34 months (range 1-109 months). The median survival after the first stent insertion was 15.3 months (95% CI 15.1, 15.6). Seven patients had worsening renal function and hydronephrosis despite indwelling stents. In these patients, the median time from the first stent to a rising serum creatinine concentration was 17 months (range 1-66 months). No patient required dialysis. Eighteen patients developed a total of 69 urinary tract infections (mean 2.5). Eight patients had a total of 13 episodes of urosepsis. The median infection-free survival was 11.9 months (range 7.7-16.9 months). The median urosepsis-free survival was 28.5 months (range 9.7-47.1 months). Fourteen patients died from their malignancies during the study.
  
  
  CONCLUSIONS
  Stent-change therapy is an efficacious way to treat patients with advanced malignancies and ureteral obstruction, many of whom have a short life expectancy. All patients maintained adequate renal function to obviate dialysis. Most patients with stents in place will die before their renal function deteriorates. They may also benefit from treatment strategies designed to avoid the occurrence of frequent urinary infections.
authors.affiliation: Department of Urology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Rosenberg
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Bianco
authors.forename: David P
authors.initials: DP
authors.lastname: Wood
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Triest
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000150:complications*; D012086:Reoperation; D012186:Retroperitoneal Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D014519:Ureterostomy / Q000295:instrumentation*