title: Long-term results of metallic stents for malignant ureteral obstruction in advanced cervical carcinoma.
abstract: OBJECTIVE
  We present our experience with the use of metallic stents (Wallstents®) in the management of malignant ureteral obstruction to maintain renal function, thereby permitting the use of chemotherapeutic agents to treat the underlying malignancy.
  
  
  METHODS
  We retrospectively reviewed the records of 24 patients with ureteral obstruction secondary to advanced cervical carcinoma, stage T3b (n=10) and T4 (n=14), that was relieved by Wallstents. Nineteen patients needed bilateral and 5 needed unilateral Wallstents to relieve the obstruction. Fifty-six additional endourologic interventions were necessary to assure continued patency. Holmium laser ablation was used 14 times to manage tumor proliferation and ingrowth at the distal end of the stent. Thirty-two endostents, 4 extension, and 6 replacement stents were used to maintain patency of the ureter.
  
  
  RESULTS
  Nineteen of our 24 patients received between one and five chemotherapeutic cycles over 18 to 140 months. In five patients, placement of Wallstents did not achieve adequate decrease of the creatinine levels to allow treatment with chemotherapy. Thirteen of 24 Wallstents remained patent over 18 months, yielding a primary patency rate of 54%. Technical success rate of Wallstent placement was 100%. The overall mean primary and secondary patency rates of the stent were 16.5 and 52 months, respectively. For T3b and T4 patients, the mean primary patency rates were 20.6 and 13.6 months, respectively. Secondary patency for T3b patients was 73.9 months vs 36.4 months for T4 patients. There were no serious complications associated with Wallstent placement.
  
  
  CONCLUSIONS
  Wallstents offer a salutary solution to the problem of maintaining prolonged patency of ureters compromised by encasing neoplasms.
authors.affiliation: Departments of Urology and Radiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: Erich K
authors.initials: EK
authors.lastname: Lang
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Winer
authors.forename: Geraldine
authors.initials: G
authors.lastname: Abbey-Mensah
authors.forename: Raja
authors.initials: R
authors.lastname: Anne
authors.forename: Atabak
authors.initials: A
authors.lastname: Allaei
authors.forename: Fara
authors.initials: F
authors.lastname: Friedman
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
authors.forename: Joseph
authors.initials: J
authors.lastname: La Nasa
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology