title: The burden of chronic ureteral stenting in cervical cancer survivors.
abstract: OBJECTIVE
  Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain).
  
  
  METHODS
  From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The "no cancer" group was drawn from the 5% Medicare sample.
  
  
  RESULTS
  117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women.
  
  
  CONCLUSIONS
  The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldfarb
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Jarosek
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000150:complications*
keywords: Neoplasms; Survivors; Ureteral Obstruction