Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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A Prospective Randomized Comparison of a Covered Metallic Ureteral Stent and a Double-J Stent for Malignant Ureteral Obstruction

  • Kim, Jong Woo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Bumsik (Department of Urology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shin, Ji Hoon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Jihong (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Jin Hyoung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Gwon, Dong Il (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ryu, Min-Hee (Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ryoo, Baek-Yeol (Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2017.11.05
  • Accepted : 2017.12.29
  • Published : 2018.08.01
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Abstract

Objective: To compare the safety and efficacy between a covered metallic ureteral stent (CMS) and a double-J ureteral stent (DJS) for the treatment of a malignant ureteral obstruction (MUO). Materials and Methods: Nineteen patients (seven men and 12 women; mean age, 53.4 years) were randomly assigned to the CMS (n = 10) or DJS (n = 9) group. The following were compared between the two groups: technical success, i.e., successful stent placement into desired locations; stent malfunction; stent patency, i.e., no obstruction and no additional intervention; complications; and patient survival. Results: The technical success rate was 100% in all 10 and 12 ureteral units in the CMS and DJS groups, respectively. During the mean follow-up period of 253.9 days (range, 63-655 days), stent malfunction was observed in 40.0% (4/10) and 66.7% (8/12) in the CMS and DJS groups, respectively. In the per-ureteral analysis, the median patency time was 239.0 days and 80.0 days in the CMS and DJS groups, respectively. The CMS group yielded higher patency rates compared with the DJS group at three months (90% vs. 35%) and at six months (57% vs. 21%). The overall patency rates were significantly higher in the CMS group (p = 0.041). Complications included the migration of two metallic stents in one patient in the CMS group, which were removed in a retrograde manner. The two patient groups did not differ significantly regarding their overall survival rates (p = 0.286). Conclusion: Covered metallic ureteral stent may be effective for MUO.

Keywords

Acknowledgement

Supported by : Asan Medical Center

References

  1. Better OS, Arieff AI, Massry SG, Kleeman CR, Maxwell MH. Studies on renal function after relief of complete unilateral ureteral obstruction of three months' duration in man. Am J Med 1973;54:234-240 https://doi.org/10.1016/0002-9343(73)90228-3
  2. Russo P. Urologic emergencies in the cancer patient. Semin Oncol 2000;27:284-298
  3. Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 1997;8:769-774 https://doi.org/10.1016/S1051-0443(97)70658-4
  4. Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol 2004;45:184-188 https://doi.org/10.1080/02841850410003671
  5. Saltzman B. Ureteral stents. Indications, variations, and complications. Urol Clin North Am 1988;15:481-491
  6. Chung SY, Stein RJ, Landsittel D, Davies BJ, Cuellar DC, Hrebinko RL, et al. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol 2004;172:592-595 https://doi.org/10.1097/01.ju.0000130510.28768.f5
  7. Docimo SG, Dewolf WC. High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions. J Urol 1989;142(2 Pt 1):277-279 https://doi.org/10.1016/S0022-5347(17)38729-3
  8. Lang EK, Winer AG, Abbey-Mensah G, Anne R, Allaei A, Friedman F, et al. Long-term results of metallic stents for malignant ureteral obstruction in advanced cervical carcinoma. J Endourol 2013;27:646-651 https://doi.org/10.1089/end.2012.0552
  9. Wang HJ, Lee TY, Luo HL, Chen CH, Shen YC, Chuang YC, et al. Application of resonance metallic stents for ureteral obstruction. BJU Int 2011;108:428-432 https://doi.org/10.1111/j.1464-410X.2010.09842.x
  10. Kim JH, Song K, Jo MK, Park JW. Palliative care of malignant ureteral obstruction with polytetrafluoroethylene membranecovered self-expandable metallic stents: initial experience. Korean J Urol 2012;53:625-631 https://doi.org/10.4111/kju.2012.53.9.625
  11. Trueba Arguinarena FJ, Fernandez del Busto E. Self-expanding polytetrafluoroethylene covered nitinol stents for the treatment of ureteral stenosis: preliminary report. J Urol 2004;172:620-623 https://doi.org/10.1097/01.ju.0000130674.86474.7f
  12. Pollak JS, Rosenblatt MM, Egglin TK, Dickey KW, Glickman M. Treatment of ureteral obstructions with the Wallstent endoprosthesis: preliminary results. J Vasc Interv Radiol 1995;6:417-425 https://doi.org/10.1016/S1051-0443(95)72833-0
  13. Chung HH, Lee SH, Cho SB, Park HS, Kim YS, Kang BC, et al. Comparison of a new polytetrafluoroethylene-covered metallic stent to a noncovered stent in canine ureters. Cardiovasc Intervent Radiol 2008;31:619-628 https://doi.org/10.1007/s00270-007-9087-5
  14. Chung KJ, Park BH, Park B, Lee JH, Kim WJ, Baek M, et al. Efficacy and safety of a novel, double-layered, coated, selfexpandable metallic mesh stent ($Uventa^{TM}$) in malignant ureteral obstructions. J Endourol 2013;27:930-935 https://doi.org/10.1089/end.2013.0087
  15. Kim KS, Choi S, Choi YS, Bae WJ, Hong SH, Lee JY, et al. Comparison of efficacy and safety between a segmental thermo-expandable metal alloy spiral stent (Memokath 051) and a self-expandable covered metallic stent (UVENTA) in the management of ureteral obstructions. J Laparoendosc Adv Surg Tech A 2014;24:550-555 https://doi.org/10.1089/lap.2014.0056
  16. Kim KH, Cho KS, Ham WS, Hong SJ, Han KS. Early application of permanent metallic mesh stent in substitution for temporary polymeric ureteral stent reduces unnecessary ureteral procedures in patients with malignant ureteral obstruction. Urology 2015;86:459-464 https://doi.org/10.1016/j.urology.2015.06.021
  17. Chung HH, Kim MD, Won JY, Won JH, Cho SB, Seo TS, et al. Multicenter experience of the newly designed covered metallic ureteral stent for malignant ureteral occlusion: comparison with double J stent insertion. Cardiovasc Intervent Radiol 2014;37:463-470 https://doi.org/10.1007/s00270-013-0675-2
  18. Chow PM, Chiang IN, Chen CY, Huang KH, Hsu JS, Wang SM, et al. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents. PLoS One 2015;10:e0135566 https://doi.org/10.1371/journal.pone.0135566
  19. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14(9 Pt 2):S199-S202 https://doi.org/10.1097/01.RVI.0000094584.83406.3e
  20. Denstedt JD, Wollin TA, Reid G. Biomaterials used in urology: current issues of biocompatibility, infection, and encrustation. J Endourol 1998;12:493-500 https://doi.org/10.1089/end.1998.12.493
  21. Liatsikos EN, Karnabatidis D, Katsanos K, Kallidonis P, Katsakiori P, Kagadis GC, et al. Ureteral metal stents: 10-year experience with malignant ureteral obstruction treatment. J Urol 2009;182:2613-2617 https://doi.org/10.1016/j.juro.2009.08.040
  22. Barbalias GA, Liatsikos EN, Kalogeropoulou C, Karnabatidis D, Zabakis P, Athanasopoulos A, et al. Externally coated ureteral metallic stents: an unfavorable clinical experience. Eur Urol 2002;42:276-280 https://doi.org/10.1016/S0302-2838(02)00281-6
  23. Kim M, Hong B, Park HK. Long-term outcomes of doublelayered polytetrafluoroethylene membrane-covered selfexpandable segmental metallic stents (Uventa) in patients with chronic ureteral obstructions: is it really safe? J Endourol 2016;30:1339-1346 https://doi.org/10.1089/end.2016.0462

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