title: Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents.
abstract: Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent." A comprehensive review of the literature and summary of outcomes is provided. The majority of studies encountered were retrospective with small sample sizes. The evidence is most robust for metal stents, whereas only limited data exists for tandem or metal-mesh stents. Metal and metal-mesh stents are considerably more expensive than tandem stenting, but the potential for less frequent stent exchanges makes them possibly cost-effective over time. Urinary tract infections have been associated with all stent types. A wide range of failure rates has been published for all types of stents, limiting direct comparison. Metal and metal-mesh stents show a high incidence of stent colic, migration and encrustation, whereas tandem stents appear to produce symptoms equivalent to single stents. Comparison is difficult given the limited evidence and heterogeneity of patients with malignant ureteral obstruction. It is clear that prospective, randomized studies are necessary to effectively scrutinize conventional, tandem, metallic ureteral and metal-mesh stents for their use in malignant ureteral obstruction.
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Sammy E
authors.initials: SE
authors.lastname: Elsamra
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Leavitt
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Hector A
authors.initials: HA
authors.lastname: Motato
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Justin I
authors.initials: JI
authors.lastname: Friedlander
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Siev
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Keheila
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Hoenig
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA.
authors.forename: Zeph
authors.initials: Z
authors.lastname: Okeke
mesh_terms: D006801:Humans; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects* / Q000145:classification* / Q000191:economics; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology
keywords: malignant ureteral obstruction; metal stent; metal-mesh stent; tandem ureteral stent; ureteral stent