title: Outcomes of metallic stents for malignant ureteral obstruction.
abstract: OBJECTIVE
  Malignant ureteral obstruction often necessitates chronic urinary diversion and is associated with high rates of failure with traditional ureteral stents. We evaluated the outcomes of a metallic stent placed for malignant ureteral obstruction and determined the impact of risk factors previously associated with increased failure rates of traditional stents.
  
  
  METHODS
  Patients undergoing placement of the metallic Resonance® stent for malignant ureteral obstruction at an academic referral center were identified retrospectively. Stent failure was defined as unplanned stent exchange or nephrostomy tube placement for signs or symptoms of recurrent ureteral obstruction (recurrent hydroureteronephrosis or increasing creatinine). Predictors of time to stent failure were assessed using Cox regression.
  
  
  RESULTS
  A total of 37 stents were placed in 25 patients with malignant ureteral obstruction. Of these stents 12 (35%) were identified to fail. Progressive hydroureteronephrosis and increasing creatinine were the most common signs of stent failure. Three failed stents had migrated distally and no stents required removal for recurrent infection. Patients with evidence of prostate cancer invading the bladder at stent placement were found to have a significantly increased risk of failure (HR 6.50, 95% CI 1.45-29.20, p = 0.015). Notably symptomatic subcapsular hematomas were identified in 3 patients after metallic stent placement.
  
  
  CONCLUSIONS
  Failure rates with a metallic stent are similar to those historically observed with traditional polyurethane based stents in malignant ureteral obstruction. The invasion of prostate cancer in the bladder significantly increases the risk of failure. Patients should be counseled and observed for subcapsular hematoma formation with this device.
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Zachariah G
authors: ZG
authors: Goldsmith
authors: Agnes J
authors: AJ
authors: Wang
authors: Lionel L
authors: LL
authors: Bañez
authors: Michael E
authors: ME
authors: Lipkin
authors: Michael N
authors: MN
authors: Ferrandino
authors: Glenn M
authors: GM
authors: Preminger
authors: Brant A
authors: BA
authors: Inman
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications; D002858:Chromium Alloys; D005260:Female; D006801:Humans; D008297:Male; D008982:Molybdenum; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*
chemical_list: D002858:Chromium Alloys; D008982:Molybdenum