Abstract: PD42-10
Sources of Funding: None

Introduction

Ureteral stents for malignant obstruction have been noted to have failure rates as high as 40%. In the last decade metallic long-term stents have been studied as an alternative with high cost and patient discomfort. We compared outcomes using a non-metallic long-term stent for malignant versus non-malignant ureteral obstruction.

Methods

Since 2008 we placed Bard Optima (Covington, GA) stents for ureteral obstruction in patients not deemed suitable for definitive surgical management. Goal was to exchange stents annually. Indications included – malignant obstruction (11), calculus stricture (10), retroperitoneal fibrosis (5), radiation injury (3), ileal-ureter anastomotic stricture (2) and ureteral pelvic junction (2). Patients underwent placement of long term stents with a goal to eventually maintain stents for 365 days. Patency was evaluated by passage of wire through the stent lumen. We then compared malignant vs. non-malignant obstruction to determine any differences in outcomes.

Results

A total of 24 patients and 32 renal units underwent long-term stent placement from 2008 to 2016. Eleven (34%) renal units were managed for malignant obstruction versus 21 (66%) for benign reasons. The malignant group underwent 28 stent exchanges during this period. Each patient had on average 2 exchanges with a mean dwell time of 269 days. Three patient had bilateral stents. Patency rate was 100%. The non-malignant group underwent 84 stent exchanges, and on average had 4 stent exchanges per patient with a mean dwell time of 285 days. Five patients had bilateral stents Patency rate was 89%.

Conclusions

To our knowledge this is the first long term series evaluating non-metallic ureteral stents for long-term placement for ureteral obstruction. The Bard Optima stent is a good alternative to long-term metallic stents in patients with malignant obstruction. Compared to metallic stents, our patency rate was higher than historical series. Cost is substantially lower and patient comfort has been exceptional.

Funding

None