Korean J Urol.  2013 May;54(5):316-321. 10.4111/kju.2013.54.5.316.

Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

• Yu SH
• Ryu JG
• Jeong SH
• Hwang EC
• Jang WS
• Hwang IS
• Yu HS
• Kim SO
• Jung SI
• Kang TW
• Kwon DD
• Park K
• Hwang JE
• Kim GS

• KMID: 2061513
• DOI: http://doi.org/10.4111/kju.2013.54.5.316

Abstract

PURPOSE
To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction.
MATERIALS AND METHODS
We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure.
RESULTS
A univariate analysis indicted that hypoalbuminemia (<3.5 g/dL; hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.21 to 4.86; p=0.012), elevated CRP (> or =1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS > or =1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival.
CONCLUSIONS
A mid or lower ureteral obstruction, GPS > or =1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Keyword

Neoplasm metastasis; Stents; Ureteral obstruction

MeSH Terms

C-Reactive Protein
Creatinine
Humans
Hydronephrosis
Hypoalbuminemia
Multivariate Analysis
Neoplasm Metastasis
Proportional Hazards Models
Retrospective Studies
Serum Albumin
Stents
Ureter
Ureteral Obstruction
Urinary Bladder
C-Reactive Protein
Creatinine
Serum Albumin

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