title: A single-institution experience with metallic ureteral stents: a cost-effective method of managing deficiencies in ureteral drainage.
abstract: BACKGROUND
  The limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage.
  
  
  METHODS
  Fifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, or an elevation in serum creatinine. Stent life was analyzed using the Kaplan-Meier methodology, as this was a time dependent continuous variable. A cost analysis was similarly conducted.
  
  
  RESULTS
  A total of 97 metallic stents were placed among our cohort of patients: 63 in cases of malignant obstruction, 33 in the setting of cutaneous ureterostomies, and 1 in an ileal conduit urinary diversion. Overall, stent failure occurred in 8.2% of the stents placed. Median stent life was 288.4 days (95% CI: 277.4-321.2 days). The estimated annual cost for traditional polymer stents (exchanged every 90 days) was $9,648-$13,128, while the estimated cost for metallic stents was $4,211-$5,313.
  
  
  CONCLUSIONS
  Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications and is well tolerated among patients. Metallic stents can be left in situ for longer durations and provide a significant financial benefit when compared to traditional polymer stents.
authors.affiliation: Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Baumgarten
authors.affiliation: Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA.
authors.forename: Tariq S
authors.initials: TS
authors.lastname: Hakky
authors.affiliation: Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA.
authors.forename: Rafael E
authors.initials: RE
authors.lastname: Carrion
authors.affiliation: Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Lockhart
authors.affiliation: Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals / Q000191:economics; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design / Q000191:economics*; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D015607:Stents / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter; D014517:Ureteral Obstruction / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods; D055815:Young Adult
chemical_list: D008670:Metals