Abstract: PD60-09
Sources of Funding: none

Introduction

Patient and disease characteristics influence ureteric stricture management with DJ stents, metallic stents, endoscopic, or reconstructive surgery. Memokaths are an option with reported 90-100% patency and 14-30% complication rates, but the published literature is limited by small sample size and short follow-up duration up to 22 months._x000D_ _x000D_ Objective: To independently analyse 5-year Memokath stent outcomes, identifying variables associated with good outcomes to update clinical guidelines._x000D_

Methods

Management of obstructed ureteric stricture patients with Memokath stents was reviewed independently using electronic patient records. Outcomes included time to first complication, complications' incidence and severity._x000D_ Multiple linear regression was performed identifying variables linked with particular outcomes. _x000D_

Results

100 patients aged 23-87 years (mean 57) received Memokath stents for ureteric obstruction, 59% for malignant strictures, with 20% bilateral. Only 25 patients had no complications: either alive with, or dying of their primary malignancy with their original Memokath. Median time to complication in the remaining 75 patients was 12.5 months with Memokaths lasting longer in patients with malignancy (p=0.02). _x000D_ _x000D_ Multiple linear regression analyses showed that increased eGFR (p=0.005) and age (p=0.0001) independently significantly predicted greater Memokath lifespan, while co-morbidities, stricture length and location, and underlying pathology, did not. _x000D_ _x000D_ 5 year outcomes: 25 patients had a Memokath in situ: 14 still alive with the original. 22 had other stents, while 12 required major surgery. 66% of patients with most severe complications (need for major surgery or dialysis) were in the benign group._x000D_

Conclusions

Memokaths are a reasonable option for patients with malignant ureteric obstruction and life expectancy up to 1 year. Age and eGFR greater than 45 predicted longer Memokath duration. Patient and stricture variables other than aetiology did not affect Memokath durability, but should be considered for delivery of the most appropriate patient-centred individualised care. 5 year complication rates were significantly higher than previously reported (75 vs 25%). _x000D_ _x000D_ Updated practice guidelines would aid future patient selection and counselling, as well as encouraging protocolled follow-up and patient reported outcomes assessment, when considering metallic stent drainage for ureteric obstruction._x000D_

Funding

none