Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure
Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure
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DOI：
10.1007/s10147-018-1348-6
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发表时间：
2019-03-01
影响因子：
3.3
通讯作者：
Hori, Yasuhide
中科院分区：
文献类型：
--
作者：
Matsuura, Hiroshi;Arase, Shigeki;Hori, Yasuhide
BackgroundThis study investigated the clinical outcomes of stent placement for malignant extrinsic ureteral obstruction（MUO）and predictive factors for stent failure.MethodsWe retrospectively analyzed clinical data for 91 patients with radiologically significant hydronephropathy due to MUO who undertaken successful stent placement.总共有132条输尿管被放置支架用于减压。采用考克斯比例风险模型分析支架失败的相关因素。中位失败间隔为63天。多因素分析显示，支架置入前膀胱受侵和重度肾积水是支架失败的显著预测因素。根据这两个因素将患者分为三组：低风险（两个因素都没有; 85例患者），中度风险（一个因素; 37例）和高风险（两个因素; 10例）。低风险组、中风险组和高风险组3个月时的中位无支架失效生存率分别为94.8%、71.8%和55.6%。在支架失效的输尿管中，3例低危输尿管、6例中危输尿管和0例高危输尿管再次成功更换内支架。2例低危、5例中危、7例高危输尿管行肾造瘘置换术。然而，高风险的患者可能需要考虑肾造口术或其他替代方案作为初始治疗。我们的分层模型可以更好地对输尿管支架置入术患者进行风险分层，有助于确定输尿管支架置入术的适应症。
BackgroundThis study investigated the clinical outcomes of stent placement for malignant extrinsic ureteral obstruction (MUO) and predictive factors for stent failure.MethodsWe retrospectively analyzed clinical data for 91 patients with radiologically significant hydronephrosis due to MUO who underwent successful stent placement. In total, 132 ureters were stented for the decompression. Factors related to stent failure were analyzed with a Cox proportional hazards model.ResultsStent failure occurred in 25 ureters in 20 patients. The median interval to failure was 63 days. The multivariate analysis showed that the significant predictors of stent failure were bladder invasion and severe hydronephrosis before the stent insertion. The patients were divided into three groups based on these two factors: low-risk (neither factor; 85 patients), intermediate-risk (one factor; 37), and high-risk (both factors; 10). The median stent failure-free survival rate at 3 months was 94.8% in the low-risk, 71.8% in the intermediate-risk and 55.6% in the high-risk group, respectively. Of the ureters with stent failure, there was successful re-replacement of internal stents in 3 low-risk, 6 intermediate-risk and no high-risk ureters. Replacement by nephrostomy was done in 2 low-risk, 5 intermediate-risk and 7 high-risk ureters.ConclusionThe patients considered at low-risk could be managed without stent failure by internal stenting. However, the patients at high-risk may require the consideration of nephrostomy or other alternatives as the initial treatment. Our stratification model may allow better risk stratification for patients with regard to ureteral stenting, helping to identify patients for whom ureteral stenting is indicated.