Malignant Ureteral Obstruction secondary to Stomach Cancer

Lee, Dong Hwan; Park, Seung Mahn; Jung, Suk Young; Suh, Hong Jin; Kim, Hyun Woo

Abstract

PURPOSE
Metastasis from primary malignancies anywhere in the body can spread to the retroperitoneum and lead to ureteral obstruction. We evaluated the correlation between pathologic stages of stomach cancer and ureteral obstruction, and their urologic manifestations.
MATERIALS AND METHODS
Ten patients who had ureteral obstructions caused by stomach cancer were retrospectively analysed. Medical records associated with stomach cancer, urologic symptoms and signs, and methods of urinary diversion were reviewed.
RESULTS
Pathologic stages of stomach cancer(UICC & AJC classification) at the time of primary surgery were stage III in 1 and IV in 8 patients. Mean time inteval between the diagnosis of stomach cancer and subsequent ureteral obstruction was 26.6 months(range: 2months-10years) and ureteral obstruction of 6 patients(60.0%) was discovered within 2 years. Urologic symptoms and signs were gross or microscopic hematuria(50.0%), elevated Cr(40.0%) and flank pain(40.0%). Nine out of 10 patients had one of these findings. Ureteral involvements were bilateral in 7(70.0%) and unilateral in 3 patients(30.0%). Sites of ureteral obstruction were upper ureter in 5 and midureter in 5 patients. 14 out of 17 obstructed kidneys were managed by double-J stent(7 kidneys) or percutaneous nephrostomy(7 kidneys).
CONCLUSIONS
We believe that we should take into account the possibility of ureteral obstruction by direct invasion or lymph node metastasis in patients who had advanced stomach cancer. If such patients show hematuria, uremia or flank pain, secondary ureteral obstruction should be suspected. And malignant ureteral obstruction should be detected and managed as early as possible to preserve renal function.